Behavioral Health & SUD

The denials your queue never shows you.

Built for Ohio community behavioral health and SUD agencies. The denials that don't bounce — they just quietly pay short — caught before the claim goes out.

68
Denial causes modeled
3
Top: provider, COB, modifiers
271
Eligibility re-checked before service
0
Modifiers auto-applied
The cheap denial vs. the expensive one

The denial you rework is the cheap one.

The expensive one quietly pays short and never lands in your queue. It funds someone else's quarter instead of yours.

The problem we solve

Where the money leaks on the BH rail.

A handful of causes your clearinghouse treats as one-offs. We treat them as a pattern — and catch them ahead of time.

01

Provider not affiliated on the date of service

One of the most common Ohio BH denials, and one of the most preventable. We check the rendering provider against the payer's directory before the claim goes out — so a status gap never becomes a denial you rework a month later.

Provider status
02

A new primary payer nobody caught

Coordination of benefits breaks quietly, and the takeback arrives months later. We flag COB changes the moment coverage shifts, and re-check eligibility ahead of scheduled services, so the lapse never reaches a claim.

Coordination of benefits · 270/271
03

The note says video. The modifier doesn't.

A telehealth session billed without its modifier is its own denial — and so is the wrong one. When a note's language suggests telehealth, we flag it for a human to confirm. We never auto-apply, because the keyword can false-positive.

Modifier review
04

Paid below your contracted rate

Commercial payers paying under contract. Without the contracted rates loaded, no one catches it. We compare paid-vs-expected on every line and surface the shortfall.

Payer contracts
Fits your stack, not the other way around

Works alongside your EHR and clearinghouse.

We don't replace your EHR or clearinghouse. We read the files that flow between them, find what pays wrong, and stage the fix — you submit through the same route you always have.

  • Reads ERAs, 835s, and denials from your clearinghouse
  • Checks 270/271 eligibility ahead of scheduled services
  • OhioMHAS rate validation by service and code
  • Underpayment recovery against your contracted rates
  • Stage-don't-submit — nothing leaves without you
Behavioral Health · this month
Individual therapyVerified
Provider not affiliated · DOSPre-claim flag
New primary payer (COB)Review
Recovered$14,320

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