How we can help
A practical plan.
A shared understanding.
Technical and professional components
A study’s technical component covers the equipment, staff and supplies. Its professional component covers the radiologist’s interpretation and report. Depending on who owns the equipment and who reads the study, the two are billed together or separately with the TC and 26 modifiers. Each claim should match who actually did the work.
Orders, authorizations and medical necessity
Imaging is billed against a referring provider’s order. Many payers require prior authorization for advanced imaging such as MRI and CT, and a diagnosis that supports the medical necessity of the study. Check both before the claim goes out.
“Rule out” orders
When an order says “rule out”, outpatient coding guidelines call for the signs or symptoms that prompted the study, not the condition being ruled out. When the radiologist’s report confirms a diagnosis, that diagnosis is coded instead.
Denials and follow-up
Imaging denials commonly trace back to modifiers, missing authorizations or a diagnosis that doesn’t support the study. Work each denial to its cause, correct and resubmit or appeal where there are grounds, and track the patterns.
Start by agreeing on the scope.
We’ll discuss your existing systems, the work your team handles, and the support you want from Highview. Services, access, reporting and commercial terms are agreed before work begins.
Common questions
Good to know
before the call.
How is this different from your medical billing service?
It’s claims work shaped around imaging — technical and professional components billed together or apart, authorizations for advanced studies, and orders that come from referring providers. Medical billing describes our claims workflow in general.
Do you need patient records to start?
Not for the first call. Records are shared only after a business associate agreement (BAA) is signed and a secure process is agreed. Please don’t send patient information through the website.