Nevermind, I think I figured it out. The test data that I was using came from the external PACS to begin with and I tried to anonymize it which apparently wasn't sneaky enough for the PACS and when it saw the same DICOM images coming in it jailed them and associated it with the previous prior study. When it does that, apparently it doesn't show the images being imported, so I thought it wasn't actually receiving anything.
Just ignore me, I'm just a network admin playing PACS admin for a day and not having the best of luck