For revenue cycle leaders in behavioral health
You’re losing earned revenue to denials you can fix
You’re standing up denial and AR recovery across a multi-state book of Medicaid, commercial, and military payers. We trace every denial to its root cause and run the fix to get paid. Built for behavioral health, running on the systems your team already uses.
For revenue cycle leaders in behavioral health
You’re losing earned revenue to denials you can fix
You’re standing up denial and AR recovery across a multi-state book of Medicaid, commercial, and military payers. We trace every denial to its root cause and run the fix to get paid. Built for behavioral health, running on the systems your team already uses.
For revenue cycle leaders in behavioral health
You’re losing earned revenue to denials you can fix
You’re standing up denial and AR recovery across a multi-state book of Medicaid, commercial, and military payers. We trace every denial to its root cause and run the fix to get paid. Built for behavioral health, running on the systems your team already uses.
Built and scaled AI initiatives at leading healthcare & technology organizations
The autopsy
The denial says no-auth. The auth was there.
Most tools flag a denial and hand you a worklist. We trace it to where the claim actually broke, often somewhere the denial code never points, and run the fix to get paid.
The denial
The remit comes back CO-197, precertification/authorization absent. On a worklist, that’s an open-and-shut no-auth write-off.
What a worklist does
Flags the code and drops it in a queue. A biller calls the payer, can’t find the auth, and the dollars start aging toward timely-filing.
What we trace
The authorization existed. It was filed under the facility NPI, but the claim went out under the rendering provider, so the payer never matched them. The code pointed at the wrong problem.
The fix
Re-reference the auth to the billed NPI, correct the claim, and resubmit with the auth number cited. No phone tree, no rework cycle.
Paid
The claim adjudicates on resubmission. The dollars were always earned, just stuck behind a misroute the code disguised.
Recoverable identified
$312K
across 100 denials
Top root cause
Carve-out misroute
38% of the dollars
Avg. time to fix
6 days
back-end zone
The diagnostic
A real root-cause map of your denials, in one week
Send a read-only export of your last 100 denials. You get back where each claim actually broke, how much is recoverable, and which fixes move the most money. No EHR connection, no clinical data.
Built for
- Multi-state behavioral health orgs
- Commercial + military (TRICARE/VA) payer mix
- Teams standing up a denial / AR recovery function
- Running an in-house billing team and/or a BPO
Not built for
- Generic medical practices
- Hospital RCM departments
Request your diagnostic
Why behavioral health is different
The leakage is structural to behavioral health
Generic RCM tools miss the same intersection: the payer-by-payer rules, from Medicaid to TRICARE, that decide whether a behavioral health denial actually gets recovered.
Medicaid as the dominant payer
Medicaid is the largest behavioral health payer, and the rules move by state, plan, and managed-care org. Unit limits, auth windows, and medical-necessity criteria differ in every market, so we work each state's Medicaid and MCO logic, not a national average.
Carve-outs and MBHOs
Behavioral benefits are carved out to managed behavioral health orgs, so claims misroute before anyone reads the chart. We know where they go and where they get lost.
Prior auth at ~5x physical medicine
BH gets hit with authorization requirements far more often than physical medicine, so auth-related denials pile up faster than a lean team can work them.
Graduated levels of care
PHP, IOP, and outpatient each carry distinct billing and utilization rules. A unit edit that’s correct at one level is a denial at the next.
Narrative documentation
Medical necessity rides on narrative notes, not objective markers, so these denials are common and the fix lives in the record, not a code.
TRICARE and VA dual workflow
Orgs serving military and veteran populations run a dual TRICARE/VA contractor workflow on top of everything else. We’re built for that mix, not just commercial.
42 CFR Part 2 confidentiality
Substance-use records carry consent rules beyond HIPAA. Recovery has to respect them, so the system is scaffolded for 42 CFR from the start.
How the fixing actually works
Fixing isn’t one thing, so we don’t pretend it is
Recovery spans three zones, each with a different level of automation and a different level of access.
Back-end · claims level
No EHR or clinical touch. The system diagnoses the break, corrects the claim, and resubmits to get paid. This is where the guarantee lives.
Auth-not-referenced · carve-out misroutes · coding & unit edits · COB · timely filing
Front-end · registration & eligibility
Touches the PMS. We detect the error, correct it, and prevent the next one before the claim ever goes out.
Wrong plan or subscriber captured · missed carve-out · lapsed eligibility
Clinical documentation
The highest-value, most sensitive zone. We detect the gap and draft an addendum or appeal referencing the record. Your clinician reviews and attests.
Medical-necessity gaps · missing ASAM / LOCUS elements
We never generate and submit documentation as if the clinician wrote it.
Onboarding as de-risking
Clinical access is earned, not asked for on day one
You don’t hand over the chart to find out if this works. Each phase opens only after the last one pays off.
Phase 0 · Diagnostic
Read-only denial export
Send your last 100 denials. No EHR connection, no clinical data. You get a real root-cause map and a recoverable number.
Phase 1 · Recover
Back-end denials
Connect the clearinghouse. We auto-fix and resubmit the claims-level denials, the zone the guarantee covers.
Phase 2 · Prevent
Front-end & eligibility
Add the PMS and eligibility feed. We correct registration errors and stop the next denial before submission.
Phase 3 · Clinical
Deepest integration
The most sensitive zone: 42 CFR scaffolding and concurrent-review tracking. Earned only after we’ve recovered real money.
Most teams start and stay at Phase 0 until the recoverable number speaks for itself.
The guarantee
Proven on your denials, before you commit anything
We don’t lead with a revenue multiple we can’t prove. We lead with a recoverable number built from your own claims, and a guarantee behind the recovery.
Your own denials
Not a stock case study. The recoverable number comes from your last 100 denials, scored against your payer mix.
One week
Send a read-only export and get a real root-cause map back: where each claim broke and what’s recoverable.
Downside guarantee
The diagnostic is zero-risk, and recovery is backed by a downside guarantee. If we don’t recover, you’re not out the dollars.
Request your diagnostic
The diagnostic
Send us your last 100 denials
Get a real root-cause map and a recoverable number in one week. Your data, zero risk, backed by a downside guarantee.
We only use the export to build your root-cause map. No EHR connection, no clinical data.