Radiology revenue cycle management
Radiology's biggest leak is prior authorization - imaging that needs it and does not have it is denied. AI agents detect, submit and track auths, split technical and professional components, and work the cycle end to end.
Radiology carries some of the highest prior-authorization burden in medicine, plus technical/professional component splits and modifier complexity. MedXFlow detects auth requirements, submits and tracks them, supports TC/26 and imaging coding, and runs claims, posting and denials so imaging revenue is not lost to paperwork.
Prior authorization
- Auto-detect auth requirements - Flags which imaging orders need authorization the moment they are ordered.
- Submit with documentation - Submits imaging authorizations with clinical justification.
- Status tracking - Tracks authorizations to approval and surfaces at-risk cases before the scan.
Coding & documentation
- TC / professional component split - Applies TC and 26 modifiers so technical and professional components bill correctly.
- Imaging coding support - Supports CPT imaging coding with contrast and laterality modifiers.
Eligibility & claims
- Eligibility verification - Verifies coverage and imaging benefits before service.
- Claim scrubbing - Scrubs claims against payer and bundling edits before submission.
Posting & denials
- Payment posting - Auto-posts ERAs with line-level reconciliation.
- Denial management - Works authorization and medical-necessity denials by root cause.
What you get
- Fewer authorization-related imaging denials
- Technical and professional components billed correctly
- Authorizations cleared before the scan
- Faster cash with automated follow-up
Frequently asked questions
What are the TC and 26 modifiers in radiology?
Modifier TC bills the technical component (equipment, supplies, technologist), and modifier 26 bills the professional component (the radiologist's interpretation). When one entity provides both, the study is billed globally with no split modifier.
Why does radiology have so many prior authorization denials?
Advanced imaging - MRI, CT, PET and nuclear studies - is among the most heavily authorized services in medicine, and many plans route it through a radiology benefit manager. If the scan is performed before the authorization is in place, the claim is denied and is difficult to appeal.
How do you prevent imaging authorization denials?
Detect the authorization requirement when the study is ordered, submit it with the clinical justification, and confirm the approved code matches the study actually performed before the patient is scanned. MedXFlow's agents track each authorization to a decision and escalate at-risk cases pre-scan.
What causes radiology coding denials?
Frequent causes are incorrect contrast coding (with, without, or both), missing laterality, mismatched technical and professional components, and a diagnosis that does not support medical necessity for the study ordered.