Verification of benefits and prior authorization built exclusively for behavioral health and substance use disorder treatment. Every level of care. Every major payer. Handled before your patient walks through the door.
Generic revenue cycle vendors treat behavioral health as one more specialty line. It is not. Authorization hinges on medical necessity documentation, ASAM placement criteria, and payer specific concurrent review windows that most billers have never encountered.
Currently offered: Verification of benefits and prior authorization. Denial management, underpayment recovery, and payment posting are on our roadmap and will be available to pilot partners as they launch.
Complete benefit verification for every admission, including deductible and out of pocket status, coinsurance, level of care coverage, session and day limits, and whether prior authorization is required. Delivered before admission, not after.
Authorization requests submitted the same business day with clinical documentation aligned to each payer's medical necessity criteria. We know which payers require ASAM dimension narratives and which will deny without them.
Review deadlines tracked and submitted proactively so authorizations never lapse mid treatment. A missed concurrent review turns a covered stay into an uncompensated one, and it is entirely preventable.
Structured appeals with clinical rebuttals built against the specific criteria set the payer applied. Denials get worked, escalated, and tracked to resolution rather than written off.
Systematic comparison of remittances against contracted rates. Underpayments are identified, documented, and pursued instead of quietly absorbed as contractual adjustments.
Accurate remittance posting with variance flagging, so your accounts receivable reflects reality and your finance team can trust the numbers without a manual reconciliation pass.
Behavioral health billing sits under two distinct regulatory frameworks. HIPAA governs protected health information broadly. 42 CFR Part 2 governs substance use disorder treatment records specifically, with far stricter disclosure rules and materially higher consequences for getting it wrong.
Administrative, physical, and technical safeguards across every system that touches patient data. Access is role limited, activity is logged, and all transmission is encrypted end to end.
Consent driven disclosure with explicit redisclosure prohibitions. Built into intake and authorization workflows from the first line of process design rather than layered on as a compliance checklist.
A signed agreement establishing our obligations, breach notification duties, and permitted uses is standard for every client relationship and is completed before onboarding begins.
From acute medical stabilization through long term outpatient maintenance, we handle verification and authorization at every step of the treatment pathway.
Acute stabilization requiring twenty four hour nursing and physician oversight. Authorization is typically short, granted day by day, and demands immediate concurrent review to avoid coverage gaps during the most clinically critical phase of care.
Twenty four hour structured treatment in a live in setting. Among the most heavily scrutinized levels of care for medical necessity, where documentation quality directly determines approved length of stay.
Intensive daily programming without overnight residence. Payers frequently attempt to step patients down prematurely, making the strength of your continued stay justification the deciding factor in authorization.
Structured group and individual therapy several days per week. Session limits and frequency caps vary widely between payers and plan tiers, and misreading them is a common source of avoidable denial.
Ongoing individual therapy, group work, and medication assisted treatment. Lower intensity but higher volume, where verification accuracy compounds meaningfully across a full patient panel.
Psychiatric inpatient, mental health day treatment tracks, and specialty modalities. Frequently routed through behavioral health carve out administrators with entirely separate criteria and submission channels.
No software to install and no disruption to your admissions workflow. We work inside the systems and processes your team already uses.
We map your payer mix, facility identifiers, contracted rates, and program structure. Your team keeps working exactly as it does today while we build the operational picture.
Every admission receives a complete benefit verification, with authorization requests submitted the same business day. Your admissions team knows coverage status before committing a bed.
Concurrent review deadlines are tracked and submitted ahead of expiry. Documentation gaps that would trigger a denial get flagged before submission rather than discovered on a remittance.
Behavioral health is the only thing we do, which means it is the only thing we have to be excellent at.
We do not bill orthopedics, cardiology, or primary care. Every person on the team works exclusively in behavioral health and substance use disorder claims, which is why we recognize a payer pattern the first time it appears rather than the fifth.
Benefit verification is not queued for a weekly batch. Requests are worked the business day they arrive so your admissions team knows exactly what is covered before a bed is committed.
Substance use confidentiality is designed into the workflow rather than added as a compliance layer. Consent tracking, disclosure limits, and redisclosure restrictions are handled correctly by default.
Carve out administrators apply different criteria sets than their parent plans, and those differences decide approvals. We track which payers require which documentation and adjust submissions accordingly.
You work with the same people every day, not whoever picks up the next ticket. They learn your programs, your payer mix, and your documentation patterns, and that continuity is what makes the work fast.
The most valuable denial is the one that never happens. We identify documentation gaps and authorization risks before submission, because appealing a denial costs far more than preventing it.
Every verification and authorization carries a cost your billing software never shows: time on payer phone lines, in portals, and on hold. The rules change every quarter, and no two payers apply them the same way.
We are building an AI-powered voice system that calls payers directly, navigates their authorization workflows in real time, and returns structured verification data to your team for review and submission. Your staff focuses on clinical judgment and exceptions. The system handles the calls.
Trained exclusively on behavioral health payer protocols, ASAM criteria documentation requirements, and carve out administrator workflows across our five core markets.
Join early access waitlistIn behavioral health, revenue is not lost at the claim. It is lost at the verification nobody completed and the concurrent review nobody submitted.
We handle verification and authorization across the full behavioral health continuum: medically managed detoxification, inpatient residential treatment, partial hospitalization, intensive outpatient, standard outpatient, medication assisted treatment, and psychiatric or specialty mental health programs.
Most commercial plans are verified within twenty four to forty eight hours. Government payers and behavioral health carve out administrators typically take forty eight to seventy two hours because of their separate submission channels. Nothing is held in a batch queue. Every request is worked the business day it is received.
Part 2 requirements are built into our intake and authorization design rather than applied as a review step. Substance use disorder consent is tracked as a structurally separate record from general PHI authorization, our team is trained specifically on redisclosure restrictions, and no substance use record content is included in a payer submission without valid, documented consent on file.
All major commercial carriers and their behavioral health carve out administrators, along with Medicaid managed care plans in our core markets of Texas, California, Florida, New York, and Colorado. Carve out administrators frequently apply different medical necessity criteria than their parent plans, and that distinction is where most authorization outcomes are actually decided.
We focus on mid market treatment facilities, roughly eighty to three hundred beds across residential, partial hospitalization, and intensive outpatient programming. Facilities of this size are large enough to need real operational depth but are often deprioritized by enterprise vendors chasing hospital systems.
Flat fee pricing by service volume, with tiers for higher census facilities. We deliberately avoid percentage of collections models, which reward chasing large recoverable claims over the routine verification work that actually prevents revenue loss. Pricing is finalized after a discovery call, once we understand your admission volume and payer mix.
Yes, and we consider it non negotiable in both directions. A signed business associate agreement establishing permitted uses, safeguards, and breach notification obligations is executed before any protected health information is exchanged. Onboarding does not begin until it is in place.
No. We work inside your existing electronic health record and billing systems. There is no software to purchase, no migration, and no change to how your clinical or admissions staff document their work. Onboarding is an operational handoff, not a technology project.
Book a thirty minute discovery call. We will review your payer mix, current verification turnaround, and denial patterns, then show you specifically where authorizations are being lost. No obligation and no pitch deck.
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