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.