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Compliance

Part 4 of 7: Cigna: Medical Necessity Criteria for Addiction Treatment Services

Discover how Cigna leverages ASAM criteria to define clinical necessity for substance use treatment. This blog breaks down the detailed guidelines for detox, inpatient and residential rehab, PHP, IOP, and MAT—including key billing codes and documentation tips to streamline the authorization process.

Part 3 of 7: CVS Health (Aetna): Medical Necessity Criteria for Addiction Treatment Services

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.

Part 2 of 7: UnitedHealth Group: Medical Necessity Criteria for Addiction Treatment Services

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.

Part 1 of 7: Understanding Medical Necessity Criteria in Addiction Treatment (Introduction)

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.

The Definitive Guide to Verifying Therapist Licenses: A State-by-State Resource for Treatment Centers and Providers

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.

Comprehensive Guide to Mental Health & SUD Treatment Credentialing

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.

Comprehensive Eating Disorder Treatment Planning for Behavioral Health Professionals

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.

Depression Treatment Plans: Goals, Assessment & Billing

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.

Treatment Plan for Anxiety: ICD-10 Codes, Goals, ICD-11 Updates & Best Practices

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.

ICD-10 Codes for Anxiety and Comprehensive Treatment Planning: The Ultimate Guide for Behavioral Health Providers

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.

Mastering IOP Billing: CPT Codes, Insurance Reimbursement, and Licensing

What is IOP Billing and How Does It Work? IOP (Intensive Outpatient Program) billing involves using HCPCS codes like H0015 (substance use IOP) and S9480 (mental health IOP) to submit claims for bundled daily services. Most insurers require pre-authorization, condition code 92 (for Medicare), and a minimum of 9 hours of weekly treatment to qualify for reimbursement. Proper coding, medical necessity documentation, and adherence to payer guidelines help ensure claim approval and avoid denials.

CARF vs. Joint Commission: Behavioral Health Accreditation

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: Best Practices | BehaveHealth

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.

2025 Federal Addiction & Mental Health Policy | BehaveHealth

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.

Understanding the ASAM Level of Care Certification for addiction treatment providers

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.

Everything You Need to Know About Insurance Billing for Addiction Treatment in Pennsylvania 

If you’re running an addiction treatment center, IOP program or any type of behavioral health concern in Pennsylvania, you know that addiction treatment billing in Pennsylvania is anything but straightforward.

Medicaid Addiction Treatment in Colorado | Behave Health

Colorado’s Health First program has a very robust coverage map for for Medicaid patients seeking addiction treatment and behavioral health services in the state.

Contingency Management May be Coming to an Addiction Treatment Center Near You

How does contingency management work? Why is it so controversial? What does the future of contingency management look like in the behavioral health field?

Cybersecurity and Behavioral Health: How to Protect Your Addiction Treatment Organization

As behavioral health professionals, we are entrusted with some of the most sensitive and powerful information in our patients’ lives. We owe to our patients to protect this privilege carefully.