Radiology Claims Pending for PA

A significant number of radiology claims have been denying because the claim was submitted to NCTracks before the prior approval (PA) was received. Previously, if a radiology claim was received and no PA was on file, the claim would deny. In an effort to improve the successful processing of radiology claims on first submission, effective December 21, the NCTracks system will pend a radiology claim if the PA is not found. The claim will remain pending for up to 14 days, recycling daily to check if the PA has been received from MedSolutions. If the PA is received during that timeframe, the claim will be released and continue processing. If there is no PA received after 14 days, the radiology claim will deny.

While the claim is pended, no action is required by providers. Providers should not resubmit radiology claims that are pending awaiting prior approval. Allowing time for the prior approval to be received and matched to the pended claim will simplify the radiology claim submission process by enabling more claims to process with a single submission.