Behavioral Health Insurance Appeals Management

Denied claims are not the end of the road — they're the beginning of a fight we're very good at winning. Our appeals specialists craft compelling, evidence-based appeals tailored to the specific denial reason and payer, recovering revenue that most facilities write off as lost.

Our Appeals Services

✓Level 1 and Level 2 internal insurance appeals
✓Independent Medical Review (IMR) / External appeals
✓Medical necessity appeal letters with clinical documentation
✓Coding and billing error appeals
✓Mental health parity violation appeals
✓Timely filing appeals with supporting documentation
✓Overpayment appeals
✓Coordination of benefits dispute resolution
✓State insurance commissioner complaint support

Our Strategy

Every Denial Has a Specific Strategy

A medical necessity denial requires a completely different approach than a coding error denial or a timely filing denial. We tailor every appeal to the exact denial reason.

Medical Necessity Appeals

We build clinical appeals using ASAM criteria, DSM-5 diagnoses, and peer-reviewed literature to demonstrate that the level of care was medically required.

Parity Law Violations

If an insurer applies stricter criteria to behavioral health than to comparable medical/surgical benefits, that's a federal parity violation — and grounds for a powerful appeal.

External Review Escalation

When internal appeals fail, we escalate to Independent Medical Review and, where appropriate, state insurance regulatory complaints.

FAQ

Insurance Appeals — Common Questions

What is your appeals success rate? +

Our overall appeals overturn rate is approximately 68%, compared to the national average of around 40% for behavioral health appeals. Results vary significantly by payer, denial type, and the quality of the underlying clinical documentation.

How long do appeals typically take? +

Level 1 internal appeals are typically decided within 30–60 days by the insurer. External independent reviews often take 45–90 days. We track every appeal deadline and ensure submissions are never late.

Can you appeal old denied claims from before we worked with you? +

Yes, in many cases. We conduct a backlog audit and identify denied claims that are still within their appeal filing window. Many facilities are surprised to find significant recoverable revenue in their aging denials.

Don't Write Off Those Denied Claims

There's likely significant recoverable revenue in your current denial backlog. Let's find it together.