Revenue cycle

Know what you're owed, per payer, per code.

Contracted rates stored per payer and per service, so the expected payment is on the claim before it goes out and underpayments are visible the moment the remittance posts.

See what it costs

Fee-for-service and case rates. Per-session, per-diem, and episode structures supported.

The fee schedule

What the contract says, next to what the payer actually sent.

Load the rate once per payer, per code, with effective dates. Every claim then carries an expected amount — and every remittance gets compared against it automatically.

ServiceStructureContractedPaidVariance

90837 · Individual, 60 minFee for service$168.40$168.40—

90853 · Group therapyFee for service$62.00$62.00—

H0015 · IOPPer diem$310.00$264.50−$45.50

H0010 · Residential detoxCase rate / day$925.00$925.00—

H0018 · Residential, short termCase rate / day$680.00$612.00−$68.00

Aetna · effective 01/01/26 · 6 claims paid below contract this month−$1,842

Three structures

Behavioral health does not bill one way.

An outpatient practice bills per session. A day program bills per diem. A residential facility bills a case rate on a UB-04. A platform that only understands the first one turns the other two into manual work.

Fee for servicePer session

Individual, group, family, and assessment codes billed per encounter at the contracted rate.

Per diemPer day

PHP and IOP days billed as a bundled rate, with attendance driving whether the day is billable.

Case ratePer episode

Residential and detox billed per day or per episode against the authorized length of stay, on a UB-04.

The negotiation

Bring volume, outcomes, and what you were actually paid.

Renegotiating a rate is a data conversation. Knowing you delivered 1,400 IOP days, improved 68% of episodes, and were underpaid on 6% of claims is a different meeting than asking for more money.

3billing structures, one schedule

Questions

Common questions.

How are payer contracts and rates stored?

Load the contracted rate once per payer, per code, with effective dates. Every claim then carries the expected amount before it goes out, and every remittance is automatically compared against it so an underpayment shows the moment it posts.

Which billing structures are supported?

All three that behavioral health actually uses: fee-for-service (individual, group, family and assessment codes billed per encounter), per diem (PHP and IOP days billed as a bundled rate with attendance driving billability), and case rate (residential and detox billed per day or per episode against the authorized length of stay on a UB-04). A platform that only understands per-session turns the other two into manual work.

How does this help catch underpayments?

Because each remittance line is compared to the contracted rate, a claim paid below contract — like an IOP day short $45.50 or a residential day short $68 — shows as a variance with a running monthly total rather than posting quietly as "paid." That turns rate negotiation into a data conversation about volume, outcomes and what you were actually paid.

Works with

It runs on the same record as the rest of the platform.

Clinical

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