Frequently Asked Questions

Radiology Management

Medicaid's The Radiology Management program is designed to provide prior authorization review on select high-tech outpatient elective diagnostic imaging procedures for certain Medicaid recipients.
Below are some questions people often ask about the radiology management program. Click on the questions to see the answers:

What is the Medicaid Radiology Management program?

Medicaid's Radiology Management program reviews prior authorization requests for certain high-tech outpatient diagnostic imaging procedures.

What procedures require prior authorization?

Prior authorization is required for CT, Magnetic Resonance Imaging and PET scans.

What procedures do not require prior authorization?

Nuclear Cardiology Medicine, Myocardial Perfusion Studies and studies that are not covered by the Agency.

Is prior authorization required for inpatient or emergency situations?

No. It is not necessary to contact MedSolutions to preauthorize any imaging procedure done during an inpatient stay, 23-hour observation stay or testing done in the emergency room.

Which recipients are affected by this requirement?

PA requirements apply to procedures for children, parent/caretakers (formerly known as Medicaid for Low Income families), refugees and individuals certified for Supplemental Security Income (SSI). Dual (Medicare and Medicaid) eligibles, Plan First family planning recipients, pregnant women and undocumented individuals who have been granted emergency Medicaid coverage.

How does the Medicaid prior authorization program work?

For routine prior authorization requests, the ordering physician should contact MedSolutions with the required medical information prior to the procedure being scheduled and performed. The request will be immediately approved or additional information will be requested. Upon receipt of this information, MedSolutions will render a decision within one (1) business day or as required by federal or state regulations.

How can I submit a prior authorization request to MedSolutions?

Prior authorization requests may be submitted to MedSolutions by phone at (888) 693-3211 or by fax at (888) 693-3210 between 7 a.m. and 8 p.m. Central Time. Requests may also be submitted through MedSolutions secure website at www.MedSolutionsOnline.com

What is the advantage of using the online portal?

The MedSolutions web portal may provide you with an immediate approval depending on the type of service requested. The portal also has helpful radiology reference information for your office such as a complete CPT code list, diagnostic code list, and specific guidelines to assist you in determining the most appropriate imaging for your patient's condition. The portal also offers, 24/7 access to submit cases or to check status, the ability to attach medical documentation with the initial submission and the ability to see all cases for a member.

What is MedSolutions response time?

In most cases, when sufficient clinical documentation is provided, the request can be preauthorized during the first phone call. In general, approximately 60-65 percent of all requests are approved during the initial contact.

How can I obtain a copy of the clinical guidelines used in my case?

Contact MedSolutions to request a copy of the specific guideline used in your case. All guidelines are available online at www.MedSolutionsOnline.com.

Can multiple requests be handled in one phone call?

Yes, within reason. We ask that no more than 10 prior authorization requests be given during a single phone call. You may prefer the convenience of the website which is available 24/7 for batching PA requests.

Are physicians required to obtain prior authorization before they call to schedule a procedure?

Except in an emergency, physicians should always obtain prior authorization before scheduling the patient.

What if my office has an urgent request?

If there is a clinically urgent need for testing, the ordering physician/office must call MedSolutions with the required medical information prior to the procedure being scheduled and performed. The ordering physician should attest to MedSolutions that they are submitting a clinically urgent request. The request will be immediately approved or additional information requested. MedSolutions will turn clinically urgent requests around within one business hour, or as required by federal and state regulations.

What happens if staff forgets to call and goes ahead to schedule a procedure that requires a PA?

It is important that office staff are educated on this policy. It is the responsibility of the ordering physician to obtain prior authorization. Providers performing the studies should verify that the ordering physician has obtained the necessary prior authorization before scheduling. Failure to do so may result in non-payment of the claim and recipients must be held harmless.

What does a PA number look like and how long is it valid?

The prior authorization number is a 10-digit alphanumeric number which is valid for 60 days from the date of issue. The PA number does not need to be placed on the claim form or via electronic transaction. It is highly recommended that imaging providings document and archive imaging PA numbers.

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