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Navigating the world of insurance can be overwhelming, especially when it comes to accessing behavioral health services. As a provider in this field, you may have encountered denials from insurance companies for your clients' claims. It can be frustrating and time-consuming to deal with, but understanding denial management and appeals is crucial in unlocking insurance benefits for your clients. In this blog post, we will dive into what denial management and appeals are, and how they relate to behavioral health providers. By the end, you'll have a better understanding of these processes and be better equipped to advocate for your clients' insurance coverage.

Utilization Review (UR) and prior authorization are two critical processes that play a vital role in determining the scope of behavioral health services available to patients. UR involves a comprehensive assessment of the medical necessity and appropriateness of healthcare services, whereas prior authorization refers to the process of obtaining approval from a health insurer or plan before providing specific services or procedures and filling prescriptions covered by a plan.

There is an article on Linked written by Beth Kutscher, Editor at Large at LinkedIn News that we'd like to review. Kutscher also has a group called Path to Recovery. Our COO Denise Corbisiero read the article “Doctors hate prior authorization. Some payers may be starting to soften.” Below is a summary/response of the article regarding authorizations for healthcare in general. Denise's response is directed towards Substance Use Disorder (SUD) and Mental Health (MH). Although MH Parity is law, it seldom crosses the bridge from medical to SUD and MH with the best interest of the patient in mind.

As a behavioral health provider, you focus on providing high-quality care and support to your patients. However, it's equally important to ensure that your practice's financial health is in order. One crucial aspect of financial management is effectively managing Accounts Receivable (AR) follow-up and collections. In this blog post, we'll define AR follow-up and collections and explore why they are crucial for behavioral health providers.

Complexity & Impact of Billing & Coding

RCM Starts with Verification of Benefits