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2025 January Network Connection
Presbyterian Health Plan·NM · Radiology·Provider News
Effective date
Jan 1, 2025
We identified it
Jan 1, 2025
Summary
Effective January 1, 2025, Stanson Health replaces Evolent/NIA for advanced imaging authorizations in non-emergency outpatient settings. Providers must now obtain prior authorization from Stanson for advanced diagnostic imaging studies. Evolent/NIA continues for spinal surgery authorizations only. Optum remains the authorizing entity for Presbyterian Medicare Advantage members assigned to Optum-employed PCPs.
Action Required
By January 1, 2025 (or immediately if not yet done): Billing and authorization teams must (1) update all prior authorization workflows to route advanced imaging authorization requests to Stanson Health instead of Evolent/NIA; (2) implement access to Stanson's authorization portal at php.careportal.com and train staff on the new submission process (web, phone, or fax); (3) update encounter forms and billing software to reflect that advanced outpatient imaging now requires Stanson authorization; (4) confirm spinal surgery authorizations continue through Evolent/NIA; (5) maintain separate workflow for Optum-assigned Medicare Advantage members who continue using Optum for authorization. Failure to submit to Stanson will result in claim denials and authorization delays.