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Apr 1, 2020

Radiology components reminder

If a member receives the same radiology procedure multiple times on the same day from different providers/facilities, and if your claim is denied, you would need to appeal with the applicable documentation showing that the member was seen in your office or facility.

Examples:

  • A member saw an orthopedic provider in the morning then had an appointment later at a different facility – the claim that came in second and was denied would need to be appealed.
  • A member was seen at Rhode Island Hospital in the morning, but went back to Kent Hospital that night and both hospitals rendered the same radiology exam – the claim that came in second and was denied would need to be appealed.
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