Utilization Review & Clinical Management Support

We align clinical operations with payer medical necessity standards to protect authorizations, reduce denials, and strengthen reimbursement outcomes for substance use disorder and behavioral health providers.

Our team works closely with clinical and administrative leadership, bringing practical experience from complex regulatory environments including California and Florida.

Aligning Clinical Care with Payer Requirements

Authorization approvals and continued stay reviews depend on precise documentation and clear medical necessity justification. When clinical workflows are not aligned with payer expectations, reimbursement risk increases.

We help providers create structured utilization management processes that support both patient care and financial stability.

Prior Authorization Management

We coordinate and manage prior authorizations across all applicable levels of care. This includes submission oversight, documentation review, and proactive follow up with payers to prevent gaps in coverage.

Concurrent & Retrospective Utilization Review

We support concurrent reviews to maintain authorization continuity and conduct retrospective reviews to address payer challenges after services are rendered.

Our approach focuses on clear communication, documentation accuracy, and structured escalation when necessary.

Level of Care Validation

We assist providers with level of care validation for:

• Detox
• Residential
• Partial Hospitalization Programs
• Intensive Outpatient Programs
• Outpatient services

Each level of care is evaluated against payer criteria to ensure medical necessity is clearly supported.

Clinical Documentation Guidance

We provide guidance to align clinical documentation with payer specific criteria and parity standards. Strong documentation reduces denial risk, strengthens appeals, and protects revenue.

Supporting Clinical & Financial Stability

Utilization management is not separate from revenue cycle performance. When clinical documentation, authorizations, and payer communication operate in alignment, providers experience fewer disruptions and stronger reimbursement consistency.