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 Knowledge Base: Approved Answers for Agents
Build an approved-answer knowledge base for healthcare AI agents: source ownership, scope limits, effective dates, testing, escalation, and monitoring.
13 min read · Updated Jul 28, 2026
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Family Communication in Behavioral Health Admissions
A consent-aware workflow for family updates during behavioral health admissions: recipient scope, patient preferences, revocation, Part 2, and audit trail.
13 min read · Updated Jul 28, 2026
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Behavioral Health Bed Availability Tracker for Admissions
Track real admission availability, not bed counts: live status, holds, projected openings, program constraints, waitlist routing, and a CSV bed board.
12 min read · Updated Jul 28, 2026
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Payer Records Request Response: Behavioral Health Guide
Answer a payer records request on time: deadlines, minimum necessary, psychotherapy notes, look-back limits, a per-claim packet index, and a cover letter.
11 min read · Updated Sep 21, 2026
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Behavioral Health Prepayment Review: Respond and Exit
Why behavioral-health groups land on prepayment review, how to keep cash moving, how to answer each records request, and how to ask to be released.
10 min read · Updated Sep 21, 2026
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Overpayment Demand Letter: A Behavioral Health Response
Answer an overpayment demand before offset starts: Medicare day counts, extrapolation questions, state recoupment limits, appeals, and a dispute letter.
11 min read · Updated Sep 21, 2026
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90837 Audit Letter: What It Means and How to Respond
Got a 90837 letter? The 53-minute rule, what reviewers check on 60-minute psychotherapy claims, documentation that holds up, and how a group should reply.
9 min read · Updated Sep 21, 2026
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Optum Behavioral Health Prior Authorization: 2026 Guide
How Optum Behavioral Health prior authorization works in 2026: which levels of care need review, Provider Express steps, LOCUS and ASAM, and appeals.
10 min read · Updated Sep 21, 2026
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Carelon Behavioral Health Prior Authorization: 2026 Guide
Carelon Behavioral Health prior authorization for Anthem and other plans: Availity routing, InterQual and ASAM criteria, peer review, and appeal clocks.
9 min read · Updated Sep 21, 2026
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Evernorth Behavioral Health Prior Authorization Guide 2026
Evernorth (Cigna) behavioral health prior authorization in 2026: inpatient and residential rules, the PHP change, MCG, LOCUS, ASAM criteria, and appeals.
9 min read · Updated Sep 21, 2026
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Aetna Behavioral Health Prior Authorization: 2026 Guide
Aetna behavioral health precertification in 2026: levels of care on the list, Availity submission, LOCUS and ASAM criteria, peer-to-peer, and appeals.
8 min read · Updated Sep 21, 2026
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Magellan Behavioral Health Prior Authorization Guide 2026
Magellan behavioral health authorization in 2026: what needs certification, how to request it, the new Magellan Care Guidelines, and appeal paths.
9 min read · Updated Sep 21, 2026
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Payer Prior Authorization Approval Rates: 2026 Data
The CY2025 prior authorization approval, appeal and turnaround data that UnitedHealthcare, Humana, Aetna, Cigna, Anthem, Centene and 3 states posted.
15 min read · Updated Sep 21, 2026
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Level-of-Care Downgrade Appeal: Template and Criteria Map
A downloadable appeal letter for residential-to-IOP, PHP-to-IOP, and IOP-to-outpatient downgrades, plus how to map your evidence to the criteria the payer cited.
11 min read · Updated Oct 18, 2026
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ERISA Claim File Request Letter for Denied Behavioral Health Care
A downloadable letter that asks an employer-sponsored plan for the documents it relied on, citing the paragraphs that make the request free and enforceable.
10 min read · Updated Oct 18, 2026
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Was This Denial Automated? A Human-Review Request Letter
A letter that asks a payer to confirm whether an algorithm produced a behavioral-health denial, who reviewed it, and when — with the paragraphs that make the question answerable.
10 min read · Updated Oct 18, 2026
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NQTL Comparative Analysis Request: A Parity Template
How a behavioral-health provider requests a plan's nonquantitative treatment limitation analysis as the patient's representative, and what the 2026 enforcement pause does not change.
11 min read · Updated Oct 18, 2026
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CMS-0057-F Payer Readiness Tracker for Behavioral Health
A payer-by-payer tracker for the January 1, 2027 Prior Authorization API deadline, with the questions to ask each plan and what to do when the answer is vague.
11 min read · Updated Oct 18, 2026
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Authorization-to-Claim Reconciliation Checklist
The pre-submission check that catches authorization and claim mismatches — code, units, dates, place of service, rendering provider — before they become CO-197 or CO-198 denials.
10 min read · Updated Oct 18, 2026
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Concurrent Review Clock Tracker for IOP, PHP, and Residential
A tracker for the review dates that decide whether an episode continues, with the owner, evidence, and escalation fields that keep a continued stay from lapsing.
10 min read · Updated Oct 18, 2026
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Correct, Reconsider, or Appeal: A Denial Routing Decision Tree
A printable decision tree that sends each behavioral-health denial down the right path the day it arrives, so appeal effort goes where appeals are the answer.
11 min read · Updated Oct 18, 2026
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Prior Authorization Decision Clock Tracker: 72 Hours and 7 Days
Track every authorization request against the decision deadline that applies to it, and escalate in writing when a payer runs past 72 hours or 7 calendar days.
10 min read · Updated Oct 18, 2026
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Appeal Deadline Calendar for Behavioral Health Denials
The appeal windows that actually apply by plan type — ERISA, Medicare Advantage, Medicaid managed care, Marketplace — and a calendar that computes each one on the day a denial arrives.
11 min read · Updated Oct 18, 2026
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Extrapolated Recoupment: Response Clock and Challenge Points
What is actually challengeable when a payer extrapolates a sample across years of claims, which clock starts on the notice date, and the itemisation to demand first.
12 min read · Updated Oct 19, 2026
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