Message From Magellan Healthcare Specialty Clinical Guideline Task Force:
Notification of Magellan Health’s NIA 2017 Clinical Guideline changes

NIA has once again completed our annual clinical guideline review which involves an extensive clinical review by a team of physician reviewers, physician specialists, and our Magellan Healthcare Medical Directors. All NIA standard guidelines are reviewed; however, we are only providing you with those guidelines that were revised. These guideline changes are supported by literature reviews and practice experience and are approved by the NIA Chief Medical Officer, Chief Executive Officer and Board of Directors.

Included with this letter are crosswalks of your specific NIA guideline changes and a copy of each updated guideline. The crosswalk identifies the specific changes made within the guideline to a clinical indication that is currently in use today. Our most significant guideline change is to the Stress Echocardiography guideline. The process that went into the revision of this guideline involved an extensive clinical review by a team of cardiac physician reviewers, cardiology specialists, and our team of Medical Directors.

The revised Stress Echocardiography guideline presents our clinical criteria in relation to various clinical scenarios and incorporates discussion on a broad array of alternative imaging studies when appropriate for specific situations. The guideline will reduce variation in practice by promoting a more standardized approach, especially in the “uncertain” areas of clinical criteria. In addition, this document incorporates newer technologies and updated risk calculators to clarify risk stratification. Determinations will be more consistent with best practices and high standards of cardiovascular care. The body of the recommendations now focuses on Stress Echo, with MPI to be considered only when it is the “default” strategy based upon the reasons in the list provided in the Additional Information section of the Stress Echo guideline.

Highlights of some of our other guideline changes that will be implemented in January 2017 are as follows:

Global Change to applicable guidelines
  • Cancer surveillance in the “known tumor, cancer or mass” section was rewritten without specific timeframes applied.
  • More concise indications for the evaluation of neurologic symptoms or deficits.
  • For back or neck pain on all spine guidelines: Radicular symptoms are no longer required to be present if an EMG or nerve conduction study indicates a spinal abnormality.
  • Removed specific references to gender in several of our guidelines based on information from Section 1557 of the ACA. 
Cardiac (Heart) MRI
  • Stress Cardiac MRI scenarios, tissue characterization and specific valvular management scenarios were added. 
On December 5, 2016, NIA will place a link on radmd so that you can preview the complete set of our 2017 advanced imaging clinical guidelines prior to their implementation date of January 2 2017. Follow the instructions below. Meanwhile, you can continue to view all of your current guidelines by accessing your radmd account.

To access the link on radmd, please follow these steps (sign in is not required):
  • www.radmd.com – Home page.
  • Click on the “Solutions” tab from the home page main menu bar.
  • From the “Solutions” drop down list, click on “Advanced Imaging”
  • Click on the link for “Preview of NIA’s 2017 Standard Guidelines”, listed under the Document section.
    • The Table of Contents begins on page 3 of the pdf document.
    • Click once on the study to be viewed.
    • To return to the Table of Contents, click on “TOC” in the upper right hand corner above the heading of each guideline.

Remember, effective January 2, 2017, NIA will replace your current clinical guidelines with the updated 2017 version.

For questions/comments, please contact your Account Executive.

1 National Imaging Associates, Inc. is a subsidiary of Magellan Healthcare, Inc