Expertise
MindState Behavioral Health was losing revenue on intensive outpatient program claims because authorized visits were being tracked differently than billed service units. Several payers approved care by day, while claims were submitted with session-level details that did not clearly match authorization records.
MedsIT Nexus created an IOP-specific billing review layer. Our team matched each claim against authorization date span, approved units, revenue code, CPT/HCPCS detail, diagnosis support, provider credentials, and medical necessity documentation before submission. Denials were then segmented by payer, authorization mismatch, and level-of-care conflict.