The Client
A 14-provider behavioral health group serving Southern California with a mix of commercial, Medi-Cal, and EAP contracts. Roughly 4,800 sessions per month across individual, group, and telehealth services.
The Problem
Denial rate had climbed to 14% — well above the 5% benchmark. Authorization-related denials accounted for 41% of the total, and the team was writing off roughly $40K/month in prior-auth and timely-filing losses.
Our Approach
We rebuilt the authorization workflow around a payer-specific matrix, added hard-stop scheduling rules, and deployed same-day appeals for clinical denials. The framework aligns with the specialty controls in our mental health revenue cycle performance guide and the general methodology described in Top 7 Reasons Medical Claims Get Denied.
Results
- Denial rate reduced from 14% to 4% in 4 months.
- $480K in additional annual net collections.
- Authorization-related denials cut by 88%.
- First-pass appeal success rate increased from 52% to 84%.
- Eliminated all timely-filing write-offs within 90 days.