Wednesday, 25 July 2012

North Carolina Medicaid has contracted with MedSolutions to provide Radiology Authorizations

Effective from October 1, 2010 North Carolina Medicaid has contracted with MedSolutions to provide Radiology authorization for select MR, CT, PET and Ultrasound imaging studies.

Services require prior authorization
All outpatient, non-emergent, diagnostic imaging services including:
  • CT/CTA
  • MR/MRA
  • PET
  • Ultrasound
  • Outcomes Focused Cardiology
Services do not require prior authorization
  • Inpatient radiology
  • Radiology testing done in the Emergency Room
  • 23 hour observation
How can we request from MedSolutions?

We can request authorization from MedSolutions in three ways as below
  • Website       - (registration required)
  • Phone          -        Request authorization by calling 888-693-3211 (Monday to Friday @ 8.00AM to 9.00PM EDT)
  • Fax              -        Fax forms can be sent @ 888-693-3210 (Fax form available at MedSolutions web portal)
What we need to request authorization?

We need following details to request authorization through phone, fax and website
  • The patient’s name & address
  • The current Member ID
  • The procedure code and working or differential diagnosis code
  • Prior tests, lab work and/or imaging performed related to this diagnosis
  • Notes from the patient’s last visit related to the diagnosis
  • Type and duration of treatment performed to date for the diagnosis
Authorization will be faxed to the ordering physician upon approval.


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