AI Insurance ID Card Reader for Mental Health Carve-Outs and Medicaid MCOs
Behavioral health billing has many pain points—documentation, coding, authorizations—but one of the most persistent is the insurance ID card itself. Mental health benefits are often carved out from the medical plan. Medicaid members may be assigned to a medical MCO that is not the behavioral health payer. Insurance cards frequently list multiple phone numbers and logos with little...
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Is Professional Inpatient Psychiatry a Small Market?
Yes and That Is Exactly Why It Matters As behavioral health practices evolve, many eventually ask the same question: Is professional inpatient psychiatry worth supporting? The short answer is yes, it is a smaller market than outpatient psychiatry. The more important answer is why that does not make it insignificant and why, from a systems and operations perspective, it actually...
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Why Medicaid Heavy Behavioral Health Practices Are Being Forced to Outgrow Their EHRs
Behavioral health practices did not suddenly become “too complex”. The system around them did. Over the last several years, outpatient therapy and substance use disorder organizations, especially those serving Medicaid populations, have been pushed into operating models their software was never designed to handle. What used to work for low volume, private pay therapy breaks quickly...
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Medicaid Billing Isn’t One System
Understanding CMS-1500 vs UB-04 and the Services Behind Them One of the biggest mistakes behavioral health organizations make with Medicaid is assuming that billing works the same way across services. It doesn’t. Medicaid behavioral health operates in two fundamentally different billing worlds, and most EHR platforms only support one of them. Understanding the difference between...
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