Utilization Review Support for Behavioral Health Providers

Insurance companies routinely attempt to limit the duration and level of care authorized for behavioral health patients. Our UR support team works alongside your clinical staff to defend medical necessity, communicate effectively with payer reviewers, and prevent premature discharge driven by insurance pressure.

Utilization Review Services

✓Concurrent authorization requests and extensions
✓ASAM criteria and Milliman guideline documentation
✓Peer-to-peer review coordination
✓Retrospective authorization support
✓Level-of-care transition documentation (Detox → RTC → PHP → IOP)
✓Medical necessity letter preparation
✓Payer escalation and case management outreach
✓Denial prevention through proactive documentation training support

Our Approach

We Speak the Lingo

Winning UR battles requires more than clinical documentation — it requires knowing how each payer's reviewers think, which criteria they weight most, and how to frame medical necessity in their terms.

ASAM Criteria Mastery

We document across all six ASAM dimensions to build the strongest possible case for continued stay authorizations at every level of care.

Peer-to-Peer Coordination

When insurers request physician reviews, we prepare your clinical team with the specific arguments most likely to overturn a denial during a peer-to-peer call.

Level-of-Care Transition Support

We manage the documentation requirements as patients step down from Detox to RTC to PHP to IOP, ensuring authorizations follow the patient seamlessly.

FAQ

Utilization Review — Common Questions

What is concurrent utilization review? +

Concurrent UR is the ongoing process of requesting continued-stay authorizations while a patient is actively receiving treatment. Insurers typically require updates every few days to a week, depending on the level of care. Our team manages these requests proactively so authorizations never lapse.

Can you help if we've already received a denial during treatment? +

Yes. We handle retrospective authorization requests and internal appeals for denials that occur mid-treatment. The sooner you engage us, the more documentation options we have available.

Do you work directly with our clinical team? +

Yes. Our UR specialists collaborate closely with your clinical directors and case managers to gather the documentation needed. We minimize the administrative burden on your clinical staff while maximizing the quality of submissions to payers.

Protect Your Patients' Authorized Days

Stop losing revenue to preventable UR denials. Our team fights for every authorized day your patients need.