Payers automated utilization review. Most facilities still fight denials by hand.
Concurrent review cuts a stay short. Medical necessity gets questioned on a residential claim you know was clinically justified. A PHP day gets downcoded to IOP rates. Your UR team is on the phone fighting peer-to-peer while new admissions keep coming in the door. That is not your team failing. It is an uneven fight, and the money sits in your aging report until someone writes it off.
We even the odds.
We recover denied residential, detox, and PHP/IOP claims for behavioral health facilities. We appeal the way payers deny: systematic, documented, built on the ASAM criteria and level-of-care record that justified the stay. We know where the denial patterns live, in concurrent review, in level-of-care downgrades, in authorization gaps, and we pull the money back.