Marsa Health field guides
Practical answers for payer work.
Source-backed checklists, templates, buyer guides, and operating playbooks for behavioral-health teams working prior authorizations, denials, benefits, credentialing, intake, and payer operations.
Behavioral Health Prior Authorization Checklist
A step-by-step prior auth checklist for behavioral health: lock the request, verify benefits and auth rules, map evidence to criteria, track the decision.
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behavioral health prior authorization checklist
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Healthcare AI Agent RFP Template and Evaluation Guide
A healthcare AI agent RFP template: define bounded jobs, authority, tool access, identity, privacy, security, evaluation, pricing, and exit terms.
17 min read · Updated Jul 22, 2026
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Behavioral Health Utilization Review Software: Buyer’s Guide
Compare behavioral health UR software on payer policy tracking, review calendars, evidence, clinician sign-off, and appeals, with a CSV scoring matrix.
16 min read · Updated Jul 22, 2026
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Prior Authorization API Vendor Checklist for 2027
A prior authorization API vendor checklist for 2027: CMS scope, FHIR and X12 architecture, CRD, DTR, and PAS testing, contracts, and go-live gates.
17 min read · Updated Jul 22, 2026
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Behavioral Health Care Navigation Software: Buyer’s Guide
Evaluate behavioral health care navigation software on matching, outreach, scheduling, benefits, warm handoffs, directory quality, and access outcomes.
15 min read · Updated Jul 22, 2026
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Behavioral Health Provider Directory Accuracy Workflow
Keep behavioral health provider directories accurate: source authority, network and location checks, availability claims, and one correction queue.
14 min read · Updated Jul 22, 2026
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Gold Carding for Prior Authorization: 2026 Payer Pledge
What the payer prior auth pledge and gold-card programs change for behavioral health in 2026: verify code-list cuts, 90-day transitions, and escalation.
15 min read · Updated Jul 28, 2026
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AI Insurance Denial Appeals: Behavioral Health Playbook
How to appeal denials where payer AI may be involved: 2026 state disclosure laws, requesting the decision record, criteria-based appeals, and escalation.
15 min read · Updated Jul 28, 2026
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ASAM Criteria 4th Edition: Utilization Review Documentation
What the 4th edition changes for SUD level-of-care reviews, including new Dimension 6, and how to document when payers adopt it on different dates.
14 min read · Updated Jul 28, 2026
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Medicare Telehealth for Behavioral Health: 2026 Rules
Current CMS behavioral health telehealth rules: permanent home and audio-only access, the in-person visit rule starting after 2027, and a patient tracker.
14 min read · Updated Jul 28, 2026
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State Prior Authorization Laws: 2026 Multi-State Playbook
How federal CMS-0057-F rules, the 2026 wave of state prior auth laws, and ERISA limits combine, and how to turn each state's statute into case deadlines.
14 min read · Updated Jul 28, 2026
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Behavioral Health Payer Audit Response Workflow
Handle payer audits from records request to recoupment appeal: classify the audit, meet the records deadline, and contest findings on the right track.
15 min read · Updated Jul 28, 2026
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CCBHC Model and PPS: What the 2026 Expansion Changes
How CCBHC certification and the Medicaid prospective payment system change billing and payer work, what stays the same, and how new states can prepare.
13 min read · Updated Jul 28, 2026
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Behavioral Health Licensure Compacts and Credentialing
What PSYPACT, the Counseling Compact, and the Social Work Compact grant in 2026, why a privilege isn't payer enrollment, and a clinician-state register.
14 min read · Updated Jul 28, 2026
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Medicare Advantage Prior Authorization for Behavioral Health
What MA plans must follow when reviewing behavioral health care: Medicare coverage criteria first, public internal criteria, UM committees, and appeals.
14 min read · Updated Jul 28, 2026
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Generally Accepted Standards of Care: SB 855, ASAM, LOCUS
How SB 855-style laws make state-regulated plans use nonprofit criteria like ASAM and LOCUS for medical necessity, where they apply, and how to appeal.
14 min read · Updated Jul 28, 2026
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Behavioral Health Denial Codes: CARC and RARC Explained
What CO-A1, CO-16, CO-29, CO-45, CO-50, CO-197, PR-204 and other codes on your remittance mean for behavioral health claims, and the next action for each.
14 min read · Updated Sep 21, 2026
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Timely Filing Limits for Behavioral Health and CO-29 Appeals
Filing windows for Medicare, Medicare Advantage, Medicaid, and commercial plans, what counts as proof of timely filing, and copy-ready CO-29 appeal text.
14 min read · Updated Jul 28, 2026
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Retro Authorization in Behavioral Health: When It's Allowed
Payers grant retro authorization only in narrow cases, like emergency admissions, retroactive Medicaid, and portal outages. The evidence and deadlines.
14 min read · Updated Jul 28, 2026
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Claim Rejection vs. Denial: Differences and Next Steps
A rejected claim was never adjudicated: fix it and refile before the filing deadline runs out. A denied claim carries appeal rights. How to work each one.
13 min read · Updated Jul 28, 2026
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Behavioral Health Denial and Prior Authorization Statistics
Citable 2024 figures: MA plans denied 7.7% of prior auth requests and 80.7% of appeals were overturned; ACA plans denied 19% of in-network claims.
13 min read · Updated Jul 28, 2026
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Psychological Testing Prior Authorization Checklist
Get psychological and neuropsychological testing authorized: the request package, hours-to-units math by code family, educational exclusions, and denials.
14 min read · Updated Jul 28, 2026
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Golden Thread Documentation for Medical Necessity
The golden thread links diagnosis and impairment to plan goals and every session note. What it looks like at each level, plus a self-check and QA cadence.
14 min read · Updated Jul 28, 2026
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Behavioral Health Payer Contract Negotiation: Key Clauses
Negotiate the operational clauses, not just rates: filing windows, prompt-pay terms, audit lookbacks, unilateral amendments, and termination rights.
14 min read · Updated Jul 28, 2026
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Underpayment Recovery for Behavioral Health Practices
Find underpayments line by line against loaded fee schedules, learn the common causes, use prompt-pay interest rules, and track recovery in a CSV log.
14 min read · Updated Jul 28, 2026
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