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For behavioral health facilities

Stop writing off medical-necessity denials.

For programs that bill in-house: we work the denials your team does not have time for, and automate the checks that cause them.

Behavioral health RCM by level of care.

Each level of care denies for its own reasons. Here is what we watch for.

Detox billing

Withdrawal management claims go out in two different ways depending on the payer: a residential code with an H code, or a detox room and board code. Getting that wrong, or billing acute when the auth says sub-acute, is a fast way to a denial. We check the pairing and the auth before the claim leaves.

Codes:H0010H0011

Residential treatment billing

Residential days are where concurrent review cuts hurt most. We track auth end dates daily, prepare appeals that match the chart to the criteria the payer named, and support the member's external review route when it fits.

Codes:Revenue code 1001Revenue code 1002H0018

PHP billing

Partial hospitalization claims deny on units, tier and intensity. One payer counts half days, another full days. We set units by payer and make sure the notes show PHP-level hours.

Codes:H003509120913

IOP billing

IOP denials are often simple: a psychiatric code on a SUD line, a missing HCPCS, or a step-down without a new auth. Those are fixed with corrected claims, fast, before they age.

Codes:S9480H001509050906

Eating disorder programs

Eating disorder residential, PHP and IOP bill on the psychiatric codes and face the same level of care reviews. Appeals need weight, vitals and meal-support evidence tied to dates.

Codes:Revenue code 1001S9480

Commercial payers only, including self-funded and out-of-network. No Medicare, Medi-Cal or patient balances.

What we commit to

  • Report in 10 business daysYour denial review report within 10 business days of receiving a de-identified export.
  • Specialist approvalEvery appeal is approved by a specialist before it is sent.
  • Logged and reportedEvery action is logged. You get a report every week.
  • BAA before PHINo patient data until a BAA is signed, plus a Part 2 agreement for SUD records.

Commitments about how we work, not promises about payer decisions.

Questions

Do you replace our billing team?

No. We work behind your team on denials and never take over routine billing.

Which payers?

Commercial, including self-funded and out-of-network. Not Medicare, Medi-Cal or patient balances.

Where do we start?

Most programs start with a denial audit or a 20-minute denial review call.

Free guides for facility billing teams

Next step

Book a denial review.

Twenty minutes. No patient data needed.

Or email hello@skygathering.com