Behavioral Health Revenue Cycle Management

Revenue Cycle Assessment & Optimization

• Clean claim rate analysis
• Denial pattern identification
• A/R aging and recovery audit
• RCM workflow gap assessment
• Revenue leakage identification

Billing & Claims Management

• Behavioral health billing code setup
• Claim submission and scrubbing
• Clean claim rate optimization
• Timely filing management
• Payer-specific billing rules compliance

Authorization & Utilization Management

• Prior authorization workflow design
• Concurrent review documentation support
• Authorization tracking and renewal systems
• Utilization management compliance
• Medical necessity documentation standards

Denial Management & Appeals

• Denial root cause analysis by payer
• Appeal workflow development
• Clinical appeal letter preparation
• Denial rate reduction strategies
• Recovery of aged denied claims

Payer Contracting & Credentialing

• Payer network application management
• Rate negotiation and benchmarking
• Contract terms review and optimization
• Credentialing pipeline management
• Single case agreement negotiation

Reporting & Performance Systems

• RCM KPI dashboard setup
• Days in A/R tracking
• Collection rate monitoring
• Denial rate reporting by payer and code
• Executive financial reporting design

ASAM level-of-care billing, concurrent authorization requirements for higher levels of care, and high payer scrutiny on medical necessity create denial exposure that structured RCM infrastructure directly addresses.

Multi-level programs billing across outpatient, IOP, PHP, residential, and detox must maintain distinct workflows per level — with authorization requirements, documentation standards, and claim formats that vary significantly by payer.

Medication-assisted treatment billing involves J-codes, E&M coding, behavioral health add-ons, and payer-specific MOUD coverage policies that create disproportionate denial volume without optimized billing workflows.

Therapy, psychiatric evaluation, and medication management billing each carry distinct authorization profiles and payer rules. Documentation-to-billing alignment is the most common RCM gap in mental health practices.

Programs serving clients with co-occurring disorders must coordinate billing across mental health and substance use disorder services — managing dual authorization requirements and payer-specific coverage rules for integrated services.

Recovery housing billing for ancillary and support services requires clear coordination with clinical programs, accurate coding for non-clinical support services, and payer-specific documentation of medical necessity.