Behavioral Health 02

Multi-location behavioral health group lifts clean claims from 89% to 97%

A four-site behavioral health group needed a more reliable process for authorizations, claims, and payment posting across locations that had each drifted into their own habits.

Practice type
Behavioral health, four locations
Location
Midwest US
Provider count
14 clinicians
Engagement length
120-day implementation
First-pass rejections, before vs after Claims rejected on first submission, per 100 submitted.
First-pass rejections, before vs after
PeriodValuePhase
Month 1 11 Before engagement
Month 2 10 Before engagement
Month 3 7 After engagement
Month 4 5 After engagement
Month 5 4 After engagement
Month 6 3 After engagement

The challenge

Authorizations were tracked in four different places, so units lapsed mid-treatment and completed sessions were written off. Payment posting ran a week behind, which meant nobody could tell which claims had actually been paid and which had quietly denied.

Our approach

Front-office handoffs were aligned to one shared billing workflow across all four sites, authorization units and expiry dates moved into a single tracked view, and outstanding claims became visible to site managers rather than only to billing.

89% → 97% Clean claim rate
61 → 42 A/R days
120 days To full implementation
4 Locations covered

How the engagement unfolded

  1. Week 1–3 Site-by-site audit Documented how each location actually handled intake, authorization and posting — which turned out to be four different ways.
  2. Week 4–8 One shared workflow Standardised the front-office handoff and moved authorization tracking into a single view with expiry alerts.
  3. Week 9–14 Posting and follow-up Brought payment posting current, then worked the backlog of unresolved claims each site had accumulated.
  4. Week 15–17 Handover and reporting Site managers took on weekly outstanding-claim review with reporting built for non-billing staff.

The authorization tracking alone changed how we work. We stopped writing off sessions our clinicians had already delivered.

Operations director, behavioral health group (name withheld at the practice’s request)

Figures on this page are an illustrative example of a typical engagement, not measured results from a named client. Your own outcome depends on your payer mix, specialty and current workflow.

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