The most-denied specialty deserves the best appeals
Behavioral health claims are denied roughly 85% more often than medical — usually on medical necessity and prior auth. Those are exactly the denials a payer-specific appeal overturns.
Medical necessity is a moving target
Payers apply ASAM, MCG, and InterQual criteria inconsistently, and concurrent reviews for residential and IOP/PHP mean the fight never stops. Denial rates of 12–20% are normal — and every denied session is real revenue and real care at stake.
- 12–20%typical behavioral-health denial rate
- ~85%more denials than comparable medical claims
- 80%+overturn rate on well-argued BH appeals
Medical-necessity appeals, drafted to the criteria
Cites the right criteria
Appeals reference the specific ASAM/MCG/InterQual basis and the payer's published policy, not a generic template.
Keeps up with concurrent review
Turn the relentless concurrent-review and denial cycle from a time sink into a fast, repeatable workflow.
Recovers abandoned sessions
The small-dollar session denials your team can't get to become worth appealing when each one takes seconds.
See what you're leaving on the table — free
Send a sample remittance file and we'll return a ranked recovery worklist plus three ready-to-send appeal letters. No commitment, no integration.