MedSolutions Radiology Management Program
Effective February 1, 2008, MedSolutions, Inc. will administer FCHP's prior notification program for all outpatient MR, CT, Nuclear Cardiac, and PET imaging studies for most FCHP members.
Note: Imaging procedures performed during an inpatient admission or emergency room visit are not included in this program.
All outpatient MR, CT and PET imaging services will be evaluated based on the applicable terms of the health benefit plan (including but not limited to medical necessity) and require a prior notification number by MedSolutions. Covered imaging studies must be performed at a facility within the FCHP participating provider network based on the member’s benefit plan.
MedSolutions will process and respond to requests for a notification number within two business days once the required information is received.
Prior notification process
There are three ways physicians can request a notification number for an imaging procedure from MedSolutions:
- Internet
Visit www.medsolutionsonline.com. For help, click the “Help” link.
- Call
Call MedSolutions toll-free at 1-888-693-3211, Monday through Friday, 8:00 a.m. to 9:00 p.m. Eastern time and give all pertinent information over the telephone. Outside of normal business hours, you may call MedSolutions and leave a voice mail for a return call the next business day. When calling MedSolutions with a request for a notification number, please have the following information available:
- Patient demographic information, including health plan member ID and date of birth.
- Current diagnosis and clinical information, including treatment history, treatment plan and medications.
- Fax
Complete a request form (Universal or Body Part Specific), for the patient, and fax your request to MedSolutions at 1-888-693-3210. To get fax forms, visit www.medsolutionsonline.com or call the MedSolutions Customer Service Department at 1-888-693-3211.
Notification numbers
Your request for a notification number will be processed within two business days after the receipt of all necessary information. A notification number will be faxed to the ordering physician and requested facility. Please note: MedSolutions will approve the facility performing the imaging study and the CPT code or codes for the diagnostic imaging.
It is the responsibility of the rendering/performing provider to confirm the requesting/referring provider completed the prior notification and consultation process for these imaging procedures. Verification of a valid notification is available via MedSolutions Web site at www.medsolutionsonline.com.
Claims submitted for procedures without prior notification are subject to rejection and the member must be held harmless. Imaging procedures rendered as part of a hospital emergency room, observation stay, surgical care or inpatient services are not subject to the new notification requirements.
Expedited requests
Medically urgent requests: For those situations where advanced imaging is required in less than two business days due to a medically urgent condition, call MedSolutions at 1-888-693-3211, Monday through Friday, 8:00 a.m. to 9:00 p.m. Eastern time for prior notification. Please have all pertinent information available for reference during the call. MedSolutions will respond within four hours of receipt of all necessary information. Please clearly indicate that the prior notification request is for medically urgent care.
Emergent imaging
Medically emergent requests: For those situations in which advanced outpatient imaging was required immediately due to a medically emergent condition call MedSolutions at 1-888-693-3211 within two business days of completing the test to provide notification. Please have the pertinent information available for reference during the call. MedSolutions’ physician reviewers will retrospectively review the request and the clinical documentation supporting the nature of the medical emergency.
Decision support services
As an added service, referring physicians and radiologists are welcome to request a clinical discussion with one of MedSolutions’ physicians on any case to assist in considering imaging study options. To request a clinical discussion, call MedSolutions at 1-888-693-321, Monday through Friday, 8:00 a.m. to 9:00 p.m. Eastern time.
MedSolutions web-based services
To sign up for MedSolutions online services, go to www.medsolutionsonline.com. For help, click the “Help” link.