Reprocessing of Denied Radiology Claims with Valid MedSolutions PA

NCTracks has already reprocessed denied radiology claims with dates of processing prior to October 17, 2014, which were identified as having valid authorizations in the MedSolutions system. We have now reviewed the denied radiology claims with dates of processing from October 18, 2014, through January 31, 2015, which have valid authorizations from MedSolutions, and identified the claims that should have paid. These claims will be reprocessed in the June 2 checkwrite. (Note that while these claims will not deny for prior approval, they could fail other edits.)

The reprocessed claims will appear in a separate section of the paper remittance advice (RA). However, there is no unique EOB associated with this reprocessing. The 835 electronic transactions will include the reprocessed claims along with other claims submitted for the checkwrite. (There is no separate 835.)

If providers have already successfully re-billed for radiology claims denied during this time period, no action will be taken.

(As of June 4, 2015, MedSolutions is now known as eviCore)

There are claims in this time period that remain denied for lack of medical justification. For these claims not paid, it has been determined that 1) an authorization was not obtained, 2) the authorization was for a different procedure, or 3) the authorization was denied as inappropriate.   (Some of these claims may represent a duplicate claim that was previously paid). MedSolutions will send a report of the remaining denied claims via secure email to the CFO of affected providers.

Note: Not all providers will receive this report. Only the providers who had claims denied and MedSolutions did not show a valid authorization in their system will receive a report.

Once providers receive the report, if they believe they had an approved authorization from MedSolutions for any denied claim, please contact MedSolutions’ Client Services department by sending an email to Client.Services@Medsolutions.com.    Please include the authorization number for the claim to help expedite the research and resolution.

CSC, MedSolutions, and NC DHHS continue to review and address the issues associated with radiology prior approval and claims payment. Additional information will be provided as it is available.