KFF’s review of Section 1115 SUD IMD-exclusion waivers tells residential operators a hard truth: Medicaid dollars in beds beyond 16 are conditional. We break down the CMS milestones, state renewal risk, and the pro forma stress tests buyers should run before closing.
Xylazine, nitazenes, tianeptine, and synthetic benzos are reshaping detox length of stay and acuity, but commercial payer grids and Medicaid MCOs have not caught up. AHS shows operators how to defend medical necessity, win single-case agreements, and stop the denial bleed.
Commercial payers are already adjusting their parity posture in response to the 2024 MHPAEA Final Rule. Brandi Cameron breaks down what behavioral health operators should be pushing for at the contracting table right now, with specific asks on rate, UM, and NQTL transparency.
Carelon, CVS/Aetna, and Blues plans are quietly building the attribution, measurement, and data plumbing for value-based behavioral health contracts. Here is what treatment center operators should demand, refuse, and measure before signing a downside-risk deal in 2025 or 2026.
Prior auth denials are still the number one revenue leak in behavioral health. Here is what the DOL, CMS, and state AGs have actually done about it, and what operators in Florida, New York, and California should change on Monday morning.
Single case agreements with United Behavioral Health are not a billing trick. They are a clinical-financial negotiation with real regulatory exposure. Here is how operators should approach SCAs given recent federal scrutiny, parity enforcement, and the OptumRx and UBH litigation history.
The Complete Guide for Mental Health and Addiction Treatment Providers Who Are Done Leaving Revenue on the Table If you have searched for behavioral health contracting and credentialing services near you, you already know the problem. The results are cluttered…
Behavioral health founders and executives frequently search, “What are the top behavioral health contracting and credentialing companies in the United States?” The volume of list-style rankings and affiliate-driven comparisons online reflects growing demand. However, most rankings blend general medical credentialing…
Behavioral health founders and executives frequently ask, “Who can get me contracted with insurance for my PHP?” The more strategic question is broader: Who can secure payer contracts across all levels of care, including outpatient, IOP, PHP, detox, residential, and…
Elevance Health, one of the nation’s largest health insurers, has announced plans to intensify its use of advanced analytics to identify outliers and high-cost billing patterns within its provider network. The initiative, disclosed during a recent earnings discussion, will focus…
