Claims Management & Appeals

We pursue reimbursement proactively and compliantly for substance use disorder and behavioral health providers.

Our claims management and appeals services are structured to reduce write offs, correct systemic issues, and recover revenue tied up in denials and payer disputes. We bring practical experience from complex payer landscapes, including California and Florida.

Active Claim Oversight

Claims do not end at submission. We continuously monitor claim status, payer responses, and processing timelines to ensure issues are addressed before revenue is lost.

Our structured tracking reduces aging claims and shortens reimbursement cycles.

Claim Status Monitoring & Follow Up

We conduct ongoing claim follow up with payers to:

• Confirm receipt and processing
• Resolve documentation requests
• Address coding edits
• Escalate unresolved delays

Persistent monitoring prevents claims from stalling in payer systems.

Denial Analysis & Root Cause Resolution

Every denial is analyzed to identify the underlying cause. We evaluate patterns tied to documentation, authorization timing, coding, or payer interpretation.

Corrective actions are implemented to reduce recurrence and improve clean claim performance.

Appeals Management

We manage appeals from first level reconsiderations through external review when appropriate. Our process includes structured documentation support, medical necessity reinforcement, and parity based arguments when applicable.

Medical Necessity & Authorization Based Appeals

Behavioral health denials often center on medical necessity or authorization disputes. We coordinate closely with clinical teams to strengthen documentation and present comprehensive appeal submissions.

Strengthening Reimbursement Integrity

Effective claims management protects revenue, improves payer accountability, and supports operational stability. Our structured approach ensures that denials are addressed strategically rather than written off prematurely.