In Part 3 of our 7-part series, we detail CVS Health’s Aetna guidelines for addiction treatment services. This post breaks down key elements—from detox and inpatient rehab to PHP/IOP and MAT—highlighting the use of ASAM Criteria, precertification protocols, and essential billing codes to ensure medical necessity and optimal reimbursement.
Explore UnitedHealth Group’s evidence-based approach to substance use disorder (SUD) treatment. Our blog breaks down how ASAM Criteria guides decisions for detox, residential rehab, outpatient programs, and medication-assisted treatment, with essential billing codes and prior authorization tips to ensure smooth reimbursement.
Welcome to our comprehensive blog series on navigating medical necessity criteria for addiction treatment by insurers. This series unpacks how leading payers—from UnitedHealth Group to Kaiser Permanente—determine coverage for detox, rehab, and therapy services. Discover in-depth analyses of ASAM guidelines, insurer-specific requirements, prior authorization protocols, and key billing codes. Whether you’re a treatment provider or healthcare administrator, our expert insights will empower you to align your documentation with industry standards and overcome coverage hurdles. Dive in to transform insurance challenges into pathways for effective patient care.
Discover the definitive state-by-state guide to verifying therapist licenses. This resource empowers treatment center staff and providers to access official licensing and complaint filing information for mental health professionals across the United States, ensuring regulatory compliance and quality care.
To illustrate, imagine an addiction treatment center juggling dozens of clients through detox, residential care, and outpatient follow-ups. Without a cohesive software system, the admissions team might use spreadsheets for intake, clinicians hand-write notes that get scanned (making it hard to search for information), and billing staff manually enter claims into a separate program.
Electronic Health Records (EHRs) have become a cornerstone of modern healthcare, and addiction treatment facilities are no exception. An EHR system is essentially a digital platform for managing patient information, replacing paper charts with a secure, accessible electronic record.
Credentialing is the backbone of professional practice in mental health and substance use disorder (SUD) treatment. It refers to the rigorous process of verifying and validating a provider’s qualifications, licensure, training, and experience before they are allowed to deliver care or receive reimbursement.
Eating disorders are among the most challenging conditions in mental health – not only because of their complex clinical presentation and high mortality rate, but also due to the myriad compliance and reimbursement hurdles that providers face.
Explore our comprehensive buyers guide on CRM systems designed for addiction treatment and mental health facilities. Learn how advanced lead management, personalized patient engagement, and automated compliance tracking can revolutionize your operations—ensuring better outcomes and improved efficiency. Get actionable insights to streamline your workflows and elevate patient care with Behave Health.
Struggling with low insurance reimbursement rates for addiction treatment and mental health services? Our comprehensive guide breaks down the essential CPT & HCPCS billing codes, payer reimbursement strategies, and expert tips to reduce denials and increase revenue. Learn how to navigate Medicaid, Medicare, and private insurance billing effectively and ensure your facility gets paid what it deserves.
Navigating the forced transition from Luminello to SimplePractice can be challenging—especially for larger behavioral health practices or those launching IOP/PHP programs. In this post, we compare Luminello, SimplePractice, and BehaveHealth to show how you can maintain smooth operations, optimize revenue, and deliver quality care. Learn why BehaveHealth stands out with advanced billing (including UB-04), team-based workflows, and integrated facility tools—essential for growing mental health organizations.
Adjustment disorder treatment planning is critical in behavioral health because it provides a roadmap for care, ensuring that clinicians, patients, and payers are all aligned on the goals of therapy.
Discover expert guidance on developing comprehensive treatment plans for depression. This in‐depth resource covers assessment, goal setting, tailored interventions, and documentation—including ICD‑10 and billing codes—to help clinicians, administrators, and behavioral health professionals deliver quality care.
This guide covers developing an effective anxiety treatment plan, including ICD-10 and ICD-11 codes (like GAD and unspecified anxiety), setting measurable goals and objectives, and ensuring compliance. It also provides a case study and FAQs, emphasizing the importance of accurate documentation and tools like Behave EHR.
Accurately coding anxiety disorders with ICD-10 and crafting a solid treatment plan are twin pillars of effective behavioral health practice. Getting the ICD-10 coding right ensures compliance, facilitates reimbursement, and paints a clear clinical picture – while a well-structured treatment plan turns that diagnosis into actionable care. This exhaustive guide will walk through everything a behavioral health provider needs to know about ICD-10 codes for anxiety and treatment planning, from coding accuracy and common pitfalls, to developing SMART goals and evidence-based interventions for anxiety. We’ll also explore how these pieces fit into behavioral health documentation and discuss the upcoming transition from ICD-10 to ICD-11 and its implications. Throughout, we’ll highlight how Behave EHR can streamline both coding and treatment planning, ensuring providers stay compliant and deliver high-quality care.
In previous posts, we covered predictions on the Trump administration’s effects on the addiction treatment and recovery residence communities. Change has been moving fast as the Trump administration makes big moves in the Executive Branch and appoints cabinet members like Robert F Kennedy, Jr. to head the Department of Health and Human Services. Today, we will update our previous predictions and highlight some new issues to watch as the developments unfold.
CARF and The Joint Commission are the two major accrediting bodies for behavioral healthcare. CARF offers a consultative approach and accredits specific programs. The Joint Commission is more medical and compliance-driven, accrediting entire organizations. Both ensure quality standards and continuous improvement but differ in scope and philosophy.
Mental health progress notes are the backbone of clinical documentation for therapists, counselors, psychologists, and other mental health professionals. These notes track a client's journey through treatment, providing a written record of each session that supports continuity of care, communication among providers, and legal and ethical accountability. High-quality progress notes ensure that care is consistent and effective, allowing any clinician involved in the case to understand the client's history and current status. They also serve as legal documents that can protect both client and clinician by evidencing the services provided and the decision-making process.
Navigating UnitedHealthcare's addiction treatment coverage can be complex. This guide offers step-by-step instructions for healthcare providers on verifying patient benefits, understanding medical necessity (ASAM criteria), obtaining prior authorizations, managing concurrent reviews, and appealing denials. Mastering these processes is crucial for streamlining workflows, minimizing payment issues, and ensuring patients receive necessary care under their UHC plans. Key steps include accurate benefit verification, comprehensive documentation of medical necessity, and timely submission of authorization and appeal requests.
The United States continues to face a devastating overdose crisis and widespread unmet mental health needs in 2025. Federal policy under the Trump administration is playing a pivotal role in shaping addiction treatment, mental health services, behavioral health programs, and recovery housing.
An outpatient addiction or mental health treatment center looking to expand into sober living housing must approach the project with careful planning. This report provides a comprehensive overview of the key considerations for adding a recovery housing component (such as a sober living home or halfway house) as a separate entity. It emphasizes compliance with regulations, sustainable financial planning, and leveraging grant funding opportunities.
The concept of recovery capital (RC) has reshaped modern addiction treatment by shifting focus from pathology to resilience. RC’s development is rooted in decades of collaborative work by researchers, clinicians, and advocates worldwide. This blog post explores the pioneers, tools, and frameworks that built the RC paradigm—and how they continue to inform strengths-based care today.
Much to the chagrin of behavioral health industry leaders, President Trump has not made his second term plans for behavioral health policy especially clear in the days leading up to his inauguration.
When it comes to behavioral health marketing - and digital marketing, in particular - there’s one certification that stands out: Legitscript certification.
Unlike The Joint Commission’s accreditation program or CARF’s accreditation program, the ASAM Level of Care Certification program looks specifically at how a program fits into the ASAM Criteria.
TJC certification not only raises your organization’s profile within the behavioral health community, in many states it also makes your organization eligible for Medicaid and Medicare reimbursements.
If you're considering expanding your existing medical or mental health practice into a full-fledged addiction treatment center in Ohio, you're making a timely decision. The state is facing a significant challenge with substance abuse, particularly opioids, and there's a growing need for quality treatment options.
Need a handy list of the most commonly used CPT and HCPCS code modifiers that addiction treatment billers will use in 2024? Find it here.
We are excited to announce that Behave Health is launching a new effort to expand and consolidate our startup consulting, accreditation, and licensing services under a single umbrella, called Behave360.
