West Virginia flag

Radiology Billing Services in West Virginia

Built for Palmetto GBA’s four-state Jurisdiction M rules and a commercial insurance market Highmark controls outright, we keep West Virginia radiology groups paid accurately and on time.

Radiology Billing Built For West Virginia's Realities

From the Eastern Panhandle to the Ohio Valley, West Virginia radiology groups bill against a four-state Medicare jurisdiction, a Medicaid foster-care carve-out, and one payer controlling the commercial market outright.

Jurisdiction M Medicare rules shared with three other states

Mountain Health Trust Medicaid with a dedicated foster-care plan

Compact-based licensure for out-of-state physicians

30 to 40 days to pay a clean claim

Processed Claim Value
$ M+
Avg. A/R Collection Time
0 Days
Turn Around Time (TAT)
0 Hours
Client Retention Rate
0 %
Annual Claims
0 M+
First-Pass Claim Rate
0 %
Avg. Revenue Growth
8- 8 %
Avg. Denial Reduction
0 %

What Makes West Virginia Radiology Billing Different

Four regulatory layers shape every claim we file for West Virginia radiology practices.

Jurisdiction M Medicare Rules

Palmetto GBA processes Medicare Part A and B claims for Jurisdiction M, covering West Virginia, Virginia, North Carolina, and South Carolina. A coverage update out of any of those three other states applies just as directly to a radiology group in Huntington. We track Palmetto’s specific bulletins so West Virginia claims match the standard actually enforced across all four states.

A Foster-Care Medicaid Carve-Out

West Virginia’s Mountain Health Trust runs through four managed care organizations: Aetna Better Health, The Health Plan, Wellpoint, and Highmark Health Options. Children in state custody are carved out into a separate plan, Mountain Health Promise, with its own enrollment and claim rules. A billing team treating every Medicaid claim the same way misses that distinction entirely.

Compact-Based Licensure

West Virginia has belonged to the Interstate Medical Licensure Compact since 2015, giving physicians licensed in other member states an expedited path to a West Virginia license. That shortens the runway for a radiology group bringing in out-of-state coverage, but only if credentialing and payer enrollment are built around the compact timeline rather than the standard one.

30-to-40-Day Prompt Pay Standard

Under West Virginia Code 33-45-2(a), insurers must pay a clean electronic claim within 30 days and a manual claim within 40 days. Claims still unpaid after the 40-day mark draw interest at 10 percent annually, owed automatically without a provider demand. We build West Virginia claims clean on the first pass so they clear inside that window.

Complete Radiology Revenue Cycle Management

Certified CIRCC and CPC coders handle every CPT code, modifier, and global billing rule specific to diagnostic and interventional radiology — maximizing reimbursement on every encounter across all modalities and payer types.

Where West Virginia Radiology Billing Breaks Down

A four-state Medicare jurisdiction, a Medicaid program split by a foster-care carve-out, and a 30-to-40-day prompt pay clock all add friction most billing teams aren’t built to absorb.

Before RBS

Foster-care Medicaid claims filed under the wrong plan

Jurisdiction M denials reworked from scratch every time

Compact licensure timelines left unplanned and unused

Clean claims slipping past the 30-to-40-day clock

Annual interest penalties absorbed instead of collected

After RBS

Mountain Health Promise claims routed to the correct plan

Jurisdiction M appeals built on tracked Palmetto bulletins

Compact licensure timelines planned into every new hire

Every clean claim timestamped against the prompt pay clock

Annual interest tracked and collected, not written off

Precision RCM & Coding Built for Radiology

Generic billing is the fastest way to a denied radiology claim. RBS delivers specialty-specific revenue integrity built for imaging’s TC/PC splits and modifier rules, so you capture every dollar you’re owed.

Diagnostic Radiology

CT Scan

MRI & MRA

Nuclear Medicine

PET / PET-CT

Ultrasound

Interventional Radiology

Teleradiology

Mammography

DEXA / Bone Density

Hospital Radiology

Radiation Oncology

Coverage Confirmed for Every Payer You Work With

From national carriers to regional Medicaid plans, coverage is checked against the exact payer, plan, and product type on file — never a generic match. Every result reflects current payer policy, not outdated data from months ago.
medicare
Medicaid
Molina health
Ambetter health
cigna
Elevance Health (Anthem)
United healthcare
aetna
Blue cross Blue shield
OSCAR health
Health Net
Kaiser Permanente
tricare
wellcare
Humana
medicare
Medicaid
Molina health
Ambetter health
cigna
Elevance Health (Anthem)
United healthcare
aetna
Blue cross Blue shield
OSCAR health
Health Net
Kaiser Permanente
tricare
wellcare
Humana
medicare
Medicaid
Molina health
Ambetter health
cigna
Elevance Health (Anthem)
United healthcare
aetna
Blue cross Blue shield
OSCAR health
Health Net
Kaiser Permanente
tricare
wellcare
Humana

Serving Radiology Practices Across West Virginia

From Charleston and Huntington to Morgantown, Parkersburg, and the Eastern Panhandle, we bill for radiology groups and their hospital partners across the state.

Charleston & the Kanawha Valley

Cities
  • Charleston
  • South Charleston
  • St. Albans
Counties
  • Kanawha County

Huntington & the Tri-State Area

Cities
  • Huntington
  • Barboursville
  • Milton
Counties
  • Cabell County

Morgantown & North Central West Virginia

Cities
  • Morgantown
  • Fairmont
  • Westover
Counties
  • Monongalia County

Parkersburg & the Mid-Ohio Valley

Cities
  • Parkersburg
  • Vienna
  • Williamstown
Counties
  • Wood County

Wheeling & the Northern Panhandle

Cities
  • Wheeling
  • Weirton
  • Moundsville
Counties
  • Ohio County

Martinsburg & the Eastern Panhandle

Cities
  • Martinsburg
  • Charles Town
  • Ranson
Counties
  • Berkeley County
  • Jefferson County

Wired Into Every System You Already Run

Your EHR, RIS, and PACS stay exactly as they are. We plug our coding workflow directly into what you already use — no migration, no new login for your radiologists, no disruption to how your team already works.

Built for a Market One Payer Controls

Highmark Blue Cross Blue Shield controls roughly 80 percent of West Virginia’s commercial health insurance market, among the most concentrated in the country. A May 2026 Families USA study found West Virginia hospitals charge commercial insurers 337 percent of Medicare rates, the third-highest markup nationally. A practice that can’t bill cleanly against Highmark has almost no other commercial payer to fall back on.
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Frequently Asked Questions

What Medicare Administrative Contractor handles West Virginia radiology claims?

Palmetto GBA processes Medicare Part A and B claims for Jurisdiction M, which also covers Virginia, North Carolina, and South Carolina. We track Palmetto’s specific billing bulletins rather than generic national Medicare guidance.
West Virginia carves children in state custody out of its standard Mountain Health Trust managed care plans into a separate program, Mountain Health Promise, with its own enrollment and claim rules. We route each claim to the correct plan rather than treating all Medicaid claims as interchangeable.
Yes. West Virginia has belonged to the Interstate Medical Licensure Compact since 2015, giving physicians licensed in other member states an expedited path to practice in West Virginia. We plan credentialing and payer enrollment around that faster compact timeline rather than the standard licensure process.
Under West Virginia Code 33-45-2(a), an insurer must pay a clean electronic claim within 30 days and a manual claim within 40 days, and owes 10 percent annual interest automatically on anything still unpaid after 40 days. We track every claim’s clock so that interest gets collected instead of waived.
Yes. Highmark Blue Cross Blue Shield controls roughly 80 percent of West Virginia’s commercial health insurance market, one of the most concentrated payer positions in the country. We build claims to Highmark’s specific requirements rather than treating it as a generic commercial payer.

Get West Virginia Radiology Billing That Keeps Up

From Jurisdiction M appeals to Mountain Health Promise’s carve-out rules, let’s talk about what’s actually slowing down your reimbursements.

Jurisdiction M and Palmetto-specific claim review

Medicaid claims routed to the correct Mountain Health plan

Compact licensure timelines built into onboarding

Clean-claim tracking against the 30-to-40-day clock

Commercial billing built for Highmark's specific requirements

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What Our Clients Say?

Rebecca Lawson

★★★★★

Radiology Practice Manager

Since partnering with your radiology billing team, our billing workflow has become much smoother. They understand imaging procedures, payer requirements, coding, and claim follow-ups. Their team is responsive, professional, and always stays on top of outstanding claims.

Dr. Christopher Bennett

★★★★★

Medical Director, Diagnostic Imaging Center

Your team truly understands the challenges of radiology billing. They handle claims accurately, follow up on unpaid accounts, and help resolve billing issues efficiently. Their expertise and communication have made our revenue cycle more organized and reliable.

Dr. Andrew Whitaker

★★★★★

Radiologist & Imaging Center Owner

Our team has been an excellent partner for our imaging center. They understand radiology billing, coding, claim submission, denials, and follow-ups. Their attention to detail and consistent communication have helped streamline our billing process and improve our revenue cycle.

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