Specialties › Substance Abuse & IOP/PHP
Addiction treatment is billed on level of care, and level of care is decided by utilization review — not by the program. Authorizations are granted for a set number of days and must be extended through concurrent review while the patient is still in treatment. Programs that treat billing as a back-office task discover the problem weeks later, when an entire episode of care turns out to have been unauthorized.
These are the issues that repeat every month in substance abuse & iop/php practices — and the ones we fix at the source rather than reworking claim by claim.
Residential, PHP and IOP each require authorization, and continued stay must be justified through concurrent review during treatment. Days delivered past an expired authorization are usually unrecoverable.
Payers apply standardized level-of-care criteria. Clinical documentation must speak to those criteria specifically, or continued stay is denied regardless of clinical judgment.
Programs often bill facility services on an institutional claim and physician or therapist services professionally. Sending the wrong service on the wrong claim type denies both.
Urine drug testing is heavily scrutinized for frequency, medical necessity and definitive versus presumptive testing. It is the highest audit-risk area in the sector.
Many programs operate out of network, where reimbursement depends on negotiated agreements and persistent appeals rather than a fee schedule.
Listed for context only — this is not billing advice, and payer policy varies. Our certified coders work to AAPC and AHIMA standards.
We root-cause denials by payer and procedure, then fix the upstream workflow so the same denial stops recurring.
Your account is worked by people who bill substance abuse & iop/php every day — not a general pool learning your rules on your claims.
Relentless follow-up on every claim, with aged A/R worked rather than written off.
Performance-based pricing — a percentage of what we collect. Stay because the results are good, not because you are locked in.
We run parallel with your current process until the transition is verifiably clean.
Our certified coders work every claim; AI tools help them catch more before submission.
Strict PHI controls, access limits and staff training across the whole workflow.
We manage the authorization and billing side and work directly with your clinical team's UR process, because in this specialty an expired authorization is the difference between a paid episode and an unpaid one.
Yes. Each level has its own authorization, documentation and claim-type requirements, and we bill them as distinct workflows rather than one behavioral health process.
It carries real audit exposure around frequency and medical necessity, particularly definitive testing. We bill it conservatively and to documented necessity, which protects the program as well as the revenue.
Yes. Out-of-network work is appeal-heavy and relationship-driven. We pursue underpayments and negotiate rather than accepting the first payment as final.
★★★★★Our A/R days dropped from 58 to 31 in one quarter. First time in years I actually trust my numbers.
— Sarah M., Practice Manager
★★★★★Denials were killing us. First-pass acceptance went up fast, and they tell us why a claim failed — not just rework it quietly.
— Michael R., Billing Lead
A no-obligation A/R analysis. We review your aging, denial patterns and coding mix, then show you exactly where the recoverable revenue is.
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