Guides
Behavioral health denial guides.
Plain-English guides for SUD and mental health facility claims. Each one is sourced, dated and checked against payer and state pages.
Codes, appeals and external review
- Billing codesBehavioral health revenue codes for facility claims1001, 1002, 0905, 0906, 0912, 0913 and detox room and board, with the HCPCS codes payers ask for.Read more
- AppealsHow to appeal a behavioral health medical necessity denialConcurrent review, peer-to-peer, the appeal packet, ERISA's 180 days and the California IMR route.Read more
- External reviewCalifornia Independent Medical Review for behavioral healthDMHC and CDI review, deadlines, how facilities help members file, and 2021 to 2026 overturn rates.Read more
California payer appeal guides
- Payer guideOptum Behavioral Health appeals in CaliforniaThe two-step reconsideration and appeal process, the 12-month window and California HMO rules.Read more
- Payer guideAnthem Blue Cross California and Carelon behavioral health appealsWho handles the dispute, Anthem's three steps and Carelon's 60, 180 and 90 day windows.Read more
- Payer guideCigna and Evernorth behavioral health appeals in CaliforniaEvernorth's separate appeals unit, the 365-day California window and who can appeal what.Read more
Free tools and references
Payer Watch
Payer and denial changes, once a month.