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Audit queue/ AUD-2026-04-0001/ CLM-0000022
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Post-pay review · Sunbelt Imaging Center

Marketplace Member MBR-50913377 DOS 10 Mar 2026 Paid 24 Mar 2026 · $316.97 Recovery window closes in 33 days
Eligibility: Active on the date of service Ambetter Silver 70 HMO · Florida Prior auth: Approved and matched Advanced imaging
Review closing letter

As paid vs. as it should have been

No variance
LnCodeDescription PaidShould be VarianceResult
1 70553 MRI, brain, without contrast material, followed by contrast and further sequences
G43.109 · Migraine with aura, intractable, without status migrainosus
$316.97 $316.97 Correct

Determination

No defect in any layer

Reviewed with no variance. Every line was paid at the allowable on file.

How it was coded

Coded as documented
Billed 70553 · MRI brain without and with contrast
Supported by the record 70553 · MRI brain without and with contrast

Remedy: None — the claim was billed and priced as the record supports

Reviewed for level, severity and unit count. A single study, one unit, paid at the fee schedule allowable.

Prior authorization

Approved and matched
Authorization PA-2026-176205
Approved 2026-03-02
Valid 2026-03-02 → 2026-04-01
What was authorised MRI brain without and with contrast, one study
What was billed One study performed 10 Mar 2026

Authorised in advance and billed as authorised. Under CPP-085 v3.4 that closes medical necessity for this study — the post-service review is limited to whether it was coded and priced correctly, and it was.

Policy applied

Knowledge Center

Resolved as at the date of service, 10 Mar 2026 — not as at today.

CPP-070 Advanced imaging — medical necessity and site of service Supporting

Coverage conditions for advanced imaging, and the Florida variation that applies to this member

In force on 10 Mar 2026: v1.3 effective 2025-04-01

No source document for v1.3 is in the index, so this policy can be cited here but not quoted. Upload it.

CPP-080 Eligibility, enrolment and retroactive termination Supporting

Coverage on the date of service, and the re-verification at audit

In force on 10 Mar 2026: v6.1 effective 2026-01-01

v6.1 was extracted from CPP-080_eligibility-enrolment-retroactive-termination_v6.1.md. Passages are quoted only on the policy the finding rests on.

CPP-085 Prior authorization and post-service review Supporting

The authorization on file, and what it closes off from post-service review

In force on 10 Mar 2026: v3.4 effective 2025-11-01

v3.4 was extracted from CPP-085_prior-authorization-post-service-review_v3.4.md. Passages are quoted only on the policy the finding rests on.

Source document

Open all four views
837P_20260313_454373.edi
Availity clearinghouse · EDI 837P · received 13 Mar 2026 11:45 · claim control CCN-4820574827
Claim form As received EDI Remittance

How this was decided

Open the full trace

Walked through Professional claims post-pay review v1.9, signed off 2026-01-14.

Procedure SOP-PRO-01 — Professional claims — office visits, procedures, laboratory, imaging
Nodes walked 12
Model calls 0 — every node that resolved did so on a rule, a lookup or arithmetic
02 Mar 11:15 Prior authorization PA-2026-176205 approved Utilization management
24 Mar 10:05 Claim paid, $316.97 released to provider Payment cycle
02 Apr 18:02 Selected by advanced imaging review Autonomize
07 Apr 09:30 Reviewed, no finding D. Mercer