Outpatient psych, IOP, PHP, residential, telehealth. The full continuum.
Authorization workflows that survive UM scrutiny. Level-of-care transitions billed cleanly. Parity-Act underpayment recovery. State-Medicaid quirks handled by the desk that lives in them.
of care
Six functions designed for auth-heavy revenue.
Behavioral revenue lives or dies on authorization continuity, level-of-care defensibility, and parity-act vigilance. Generic RCM teams lose money in all three places.
Authorization workflow & UM continuity
Initial auth, concurrent review, retro auth. Tracked to the calendar day. Notes pre-staged for UM calls so the level of care doesn’t get cut for paperwork reasons.
Level-of-care transitions
Step-up and step-down between PHP, IOP, OP, and residential billed cleanly. Date discipline matters. an overlap or a gap is a denial. We track them.
Parity Act underpayment recovery
Federal MHPAEA and state parity laws are routinely under-enforced by payers. We pull the data, show the variance, and pursue recovery. including external complaints when warranted.
Telehealth coding & place-of-service
Modifier 95, GT, FQ; POS 02 vs 10; audio-only nuance. Rules shift constantly. We maintain the matrix per payer per state and update it weekly.
Medicaid & MCO billing
State Medicaid is where behavioral revenue lives, and where it gets buried. Specific MCO contract rules, T-codes, H-codes, and waiver-program billing handled by the bench, not by Google.
Single-case agreements & out-of-network
Behavioral books often run a meaningful OON volume. SCA negotiation, gap exceptions, balance billing under NSA, and IDR readiness all handled by senior partners with payer-side experience.
Six structural leak points.
Concurrent review missed
UM window passes; LOC denied retroactively. Clinical care continues, payment doesn’t.
Level-of-care overlap
Step-down billed before discharge from prior LOC. Single-day overlap denies the entire stay.
Parity-act blindness
Behavioral paid below comparable medical lines. Variance never measured, never recovered.
Telehealth code drift
POS 02 vs 10 mis-matched. Modifier 95/GT/FQ rules applied to last quarter’s policy. Denials silent.
State Medicaid quirk
T-code interpretation off by a unit definition. State manual updated; vendor didn’t notice.
OON without SCA
Out-of-network volume billed without SCA, without gap exception. Patient gets balance, you get complaints.
Five phases. Same partner.
Auth audit
30 days of active auths reviewed for continuity, documentation, UM posture. Baseline locked.
Parity read
Paid claims compared to comparable medical lines. Variance documented for compliance + board.
Cutover
Behavioral bench assigned. State-Medicaid matrix loaded. Parallel run on first cycle.
First scorecard
Auth continuity, denial rate, parity variance, AR aging. reviewed with clinical leadership.
QBR + parity refresh
Senior partner walks scorecard. Parity variance pursued. Telehealth matrix refreshed.
Six SLAs. Behavioral-specific.
| METRIC | TARGET | WHY IT MATTERS |
|---|---|---|
| Authorization continuity | 99%+ | % of LOC days with active auth on file. Tracked daily, reported weekly. |
| Concurrent-review on-time rate | 98%+ | % of UM concurrent reviews submitted before window expires. Coached, not policed. |
| Denial rate | < 6% | Behavioral-typical. auth and LOC density makes this slightly higher than physician baseline. |
| Days in AR (dollar-weighted) | 35-45 | Behavioral-typical range. State-Medicaid mix-adjusted. |
| Parity recovery | Quarterly review | Variance against comparable medical/surgical lines, with recovery actions documented. |
| Net collection rate | 94-97% | Behavioral-realistic. State Medicaid and OON volume make 98% rare. |
The bench lives in this work. They don’t rotate out.
Behavioral RCM is unforgiving. auth windows, LOC documentation, state-Medicaid quirks, telehealth-rule churn. The vendors who treat it as a side line lose money quietly. Our behavioral bench is dedicated, has 10+ years per senior, and reads the state Medicaid bulletins on Mondays.
Continuity, not generalist coverage.
- Dedicated behavioral senior. not a generic ops director with a behavioral client.
- 50-state Medicaid matrix. updated weekly, by the same desk every week.
- Telehealth rule library. per payer, per state, refreshed for each policy update.
- Parity-Act vigilance. quarterly variance review, documented for your compliance officer.
- UM-call prep. clinical narrative pre-staged, not improvised.
Four monthly outcomes.
Get a free auth-continuity audit.
Send us 30 days of active auth records. We’ll send back a continuity, documentation, and concurrent-review readiness assessment. No obligation.