Our utilization review specialists secure initial authorizations and fight for continued stay approvals so your patients receive the full course of treatment they clinically need — and your facility gets paid for every authorized day.
Discuss Your UR Needs →Utilization review is the gatekeeper between your patients and their insurance coverage. In behavioral health treatment, nearly every level of care — from detoxification to residential treatment to partial hospitalization — requires prior authorization and ongoing concurrent review. Insurance companies use the utilization review process to limit treatment days, step patients down prematurely, and deny coverage for clinically necessary care.
A weak utilization review process directly impacts your bottom line. Every denied authorization day is revenue lost. Every premature step-down means shorter lengths of stay and reduced reimbursements. At BC Billing Solutions, we treat utilization review as a revenue protection function, not just an administrative task.
Our UR team includes clinicians who understand behavioral health treatment, ASAM criteria, and medical necessity documentation inside and out. They speak the language that insurance company reviewers respond to, present clinical information strategically, and know how to counter common denial tactics.
Before treatment begins, we verify insurance benefits, confirm coverage for the requested level of care, and secure initial authorization. This eliminates billing surprises and ensures your facility has coverage confirmation before the patient walks through the door.
Throughout the patient's treatment, our UR specialists conduct concurrent reviews with the insurance company to extend authorizations. We present clinical documentation strategically using ASAM criteria and medical necessity language that supports continued treatment.
When an insurance company's clinical reviewer denies additional days, we arrange and support peer-to-peer reviews between your treating clinicians and the payer's medical director. Our team prepares your clinicians with the right talking points and documentation.
Every authorization — initial and continued stay — is tracked in real time through Claim Tracker. Your team can see authorization dates, approved days, upcoming review deadlines, and UR notes without making a single phone call.
Behavioral health utilization review is not the same as medical/surgical UR. Insurance companies evaluate behavioral health claims using specific clinical frameworks like ASAM criteria for substance use disorders and medical necessity guidelines for mental health conditions. Presenting clinical information in the wrong framework — or failing to use the right clinical language — gives payer reviewers easy grounds for denial.
Our UR specialists are trained in the documentation standards that insurance companies expect for each level of behavioral health care. They understand how to present biopsychosocial assessments, treatment plan updates, and discharge criteria in a way that demonstrates ongoing medical necessity and supports authorization extensions.
Our team uses ASAM criteria fluently to support authorization requests for substance abuse treatment.
Every additional authorized day directly protects your facility's revenue and your patients' recovery.
We track review deadlines and initiate concurrent reviews before authorizations expire.
Monitor every authorization status, approved date range, and UR note in real time.
If your current billing company is losing authorized treatment days, let us show you a better way.
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