Recurring authorizations, tracked before coverage lapses.
IOP and PHP revenue depends on authorizations that expire mid-program and concurrent reviews that ask for more each time. Marsa Health tracks every authorization window, prepares each review packet, and appeals the days payers deny.
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Authorization is recurring, not one-time
Initial authorization, concurrent review, and expiration dates are tracked per patient, with renewal alerts before coverage lapses mid-program.
Criteria differ by payer
Payers apply different criteria: LOCUS or CALOCUS for many mental-health tracks, InterQual or MCG for others, and The ASAM Criteria for substance-use tracks. Each packet is organized by the criteria that payer says it uses.
Attendance is part of the story
Reviewers look at attendance and progress against the treatment plan. Session attendance and plan updates are organized into the review packet instead of rebuilt from the chart each time.
Step-down denials need a clinical answer
‘Can be treated at a lower level of care’ is a frequent argument against continued stay. Appeals answer it dimension by dimension with the documentation that shows why the lower level will not hold.
Billed units must match the authorization
Authorized days, billed units, and the codes each payer expects for IOP and PHP are reconciled before claims go out, so a clean authorization does not become a billing denial.
PHP · concurrent review · demo data
Human approval: Level-of-care judgments stay with your clinical and utilization-review team, and a named person approves every review packet and appeal.