Choosing a teleradiology company comes down to five verifiable factors: published turnaround SLAs with a compliance number, state licensing depth, subspecialty match to your case mix, a transparent pricing model, and a documented QA methodology. For benchmark context, AstraRad reads 600,000 studies a year with a median STAT turnaround of 28 minutes and 99.4% SLA compliance over the trailing 12 months, and any credible vendor should hand you equivalent figures in writing before you sign anything. This guide gives you the 25 RFP questions that verify each factor, the pricing models compared side by side, and the red flags that should end a conversation.
The 5 evaluation criteria that matter (and the vanity metrics that don't)
Most teleradiology marketing leans on claims you cannot verify: "industry-leading turnaround," "hundreds of radiologists," "trusted nationwide." None of that predicts what happens when your ED sends a stroke protocol CT at 2 a.m. These five criteria do.
1. Published SLA numbers, not adjectives. A serious vendor states its turnaround commitments as numbers by priority tier and reports compliance against them. A defensible baseline: STAT under 1 hour, urgent under 4 hours, routine under 24 hours. AstraRad publishes exactly those tiers on its SLA page, along with the trailing 12 month compliance figure of 99.4%. If turnaround claims live only in a sales deck, they are not commitments.
2. State licensing depth. The interpreting radiologist must be licensed in the state where your patients are located. That is the default rule in US telemedicine, and the ACR practice standard goes further, expecting licensure in both the state where the study was performed and the state where it is read. Ask how the vendor manages this, how fast it can credential for a new site, and whether it uses the Interstate Medical Licensure Compact to expedite new state licenses. Our licensing hub explains how AstraRad handles this state by state.
3. Subspecialty match to your case mix. Pull your last 90 days of studies by modality and body part, then ask the vendor to map that mix to named subspecialty sections, not "our radiologists read everything." AstraRad's 240 board-certified, fellowship-trained subspecialists cover neuro, MSK, body, cardiac, breast, pediatric, chest, ER, oncologic and nuclear imaging. A vendor with genuine subspecialty depth can tell you which section reads your coronary CTA and which reads your pediatric MRI.
4. Transparent pricing. The pricing model determines your effective cost far more than the headline rate does. Minimums, platform fees, integration fees, after-hours surcharges, and priority multipliers can double an apparently low per-study price. The next section compares the three common models; our teleradiology cost guide goes deeper.
5. QA methodology with numbers attached. Ask what percentage of reports are independently double-read and what the major discrepancy rate is. AstraRad double-reads 1 in 20 reports independently and holds its major discrepancy rate under 0.3%. A vendor that runs peer review "as needed" is telling you QA happens when someone complains.
The vanity metrics to ignore: total radiologist headcount (utilization matters, roster size does not), countries served, media logos, and "years in business" claims that predate the current ownership.
RFP checklist: 25 questions to ask every teleradiology vendor
Send these in writing and require written answers. Vague responses are data.
Turnaround and coverage
- What is your median STAT turnaround time, measured from image receipt to final report?
- What are your contractual SLA tiers for STAT, urgent, and routine studies?
- What was your SLA compliance rate over the trailing 12 months, and will you report it monthly?
- Is coverage 24/7/365, including holidays, and how is overnight staffing structured?
- How much spare capacity do you hold for volume spikes, and what happens to turnaround during flu season or a backlog handoff?
Licensing and credentialing
- Are all interpreting radiologists licensed in the state where our patients are located?
- How long does it take you to credential radiologists for a new site or a new state?
- Do you use the IMLC or another expedited pathway for new state licenses?
- Will you provide license and board certification documentation for every radiologist assigned to us?
- Who is responsible for maintaining hospital privileges where they are required?
Subspecialty and quality
- Which fellowship-trained subspecialty sections will read our specific modality mix?
- What percentage of reports are independently double-read?
- What is your major discrepancy rate, and how is a discrepancy defined and adjudicated?
- How are critical findings communicated, and what is the documented notification workflow?
- For mammography, are your radiologists qualified under FDA MQSA requirements?
Pricing and contract
- What is the all-in price per study for our exact case mix, including every fee?
- Are there volume minimums, subscriptions, platform fees, or integration fees?
- How are STAT and after-hours reads priced, and is the multiplier printed on the rate card?
- What are the contract term, termination rights, and price escalation clauses?
- Does a change of company ownership trigger a right to terminate?
Technology and compliance
- How do studies reach you: DICOM from our PACS, portal upload, or a required integration project?
- How are final reports delivered, and do you support HL7 or FHIR back into our systems?
- Are you HIPAA compliant, and will you sign a Business Associate Agreement?
- Where is PHI stored, and are you GDPR compliant if any of our data touches EU jurisdictions?
- Who owns the company today, and has ownership changed in the last three years?
Any vendor that answers most of these with numbers, documents, and named processes belongs on your shortlist. Any vendor that answers with adjectives does not.
Red flags that should end the conversation
Unpublished SLAs. If turnaround commitments appear nowhere on the vendor's website or contract template, the vendor has decided not to be held to them. Treat "industry-leading turnaround" as a null answer.
Contradictory turnaround claims. It is common in this market to find one page claiming a 20 minute STAT average while the same company's services page states 30 to 60 minutes for ER cases. Read every page of a vendor's site before the sales call. Contradictions between marketing claims are a preview of contradictions between the contract and reality.
Ownership churn from consolidation. The teleradiology sector has consolidated hard: vRad into Radiology Partners, StatRad acquired by I-MED in 2024, ONRAD merged with Direct Radiology in 2025. An acquisition mid-contract can change your radiologist roster, your platform, and eventually your pricing. Ask question 25 directly, and put a change-of-control termination right in the contract.
Mandatory platform migrations. Some vendors require you to adopt their proprietary worklist or viewer before the first read. That is an integration project disguised as onboarding, and it makes leaving expensive. Prefer vendors that accept DICOM from your existing PACS or a portal upload on day one, with no integration project.
Headline rates that hide the real price. A low advertised per-study rate paired with monthly minimums, platform fees, and unlisted STAT surcharges is a pricing model built to be misread. Insist on question 16: the all-in number for your actual mix.
No stated QA numbers. "Rigorous peer review" without a double-read percentage or a discrepancy rate is a process that exists on the website and nowhere else.
Pricing models compared: per-report vs contract minimums vs FTE-equivalent
| Model | How it works | Best for | Watch out for |
|---|---|---|---|
| Per-report, no minimums | You pay a listed rate per study, by modality. Volume can be one study or ten thousand. | Imaging centers with variable volume, overflow and backlog work, groups testing a vendor | Confirm the STAT multiplier is printed on the rate card, not applied after the fact |
| Contract with minimums | Lower headline rate in exchange for a committed monthly volume or spend floor | High, stable volume with predictable case mix | You pay the floor in slow months; surcharges and platform fees often sit outside the headline rate |
| FTE-equivalent or subscription | You buy dedicated radiologist capacity in blocks, priced like staffing | Hospitals replacing a full internal shift, long-term nighthawk coverage | Highest fixed cost; capacity you do not use is still billed; hardest model to exit |
Industry-typical per-study rates vary widely by modality, from low double digits for plain film X-ray to several times that for advanced cross-sectional and PET-CT reads, and some vendors advertise per-study prices publicly while others quote only after a sales process. The structural question matters more than the sticker: whether you are paying for reads you receive or for capacity you might not use. The build-versus-buy version of this math is covered in our in-house vs outsourced radiology comparison.
AstraRad uses the first model exclusively: per-report pricing with no minimums, no subscriptions, and no platform fees, with the priority multiplier printed on the rate card. You can request the full rate card through pricing and receive it within one business day via contact.
How AstraRad answers its own checklist
We hold ourselves to the same 25 questions, in writing and in public.
| Checklist item | AstraRad's answer |
|---|---|
| Median STAT turnaround | 28 minutes, measured receipt to final report. See STAT reads under 30 minutes |
| SLA tiers | STAT under 1 hour, urgent under 4 hours, routine under 24 hours, published on the SLA page |
| SLA compliance | 99.4% over the trailing 12 months |
| Coverage | 24/7/365 across 12 time zones |
| Radiologists | 240 board-certified, fellowship-trained subspecialists across neuro, MSK, body, cardiac, breast, pediatric, chest, ER, oncologic and nuclear imaging |
| Licensing | Radiologists licensed in the state where your patients are located; details on the licensing hub |
| QA | 1 in 20 reports independently double-read; major discrepancy rate under 0.3% |
| Capacity | Headroom for 25,000 additional studies per month; an 8,000-study backlog clears in under 30 days |
| Pricing | Per-report, no minimums, no subscriptions, no platform fees, priority multiplier printed on the rate card |
| Technology | DICOM from your PACS or portal upload, no integration project; HL7/FHIR report delivery |
| Compliance | HIPAA and GDPR compliant, DICOM conformant; details on the compliance page |
| Study types | CR X-ray, mammography, ultrasound, CT including coronary CTA, MRI including cardiac, nuclear medicine gamma, PET-CT |
Run the same table on every vendor on your shortlist. The ones worth signing will fill it in without hesitation. Send one study or ten thousand: request a rate card through contact and you will have it, with every number above restated in writing, within one business day.