Every covered day, authorized, defended, and paid.
Substance-use programs live on concurrent review: days approved in short increments, criteria argued dimension by dimension, and denials that arrive after care is delivered. Marsa Health keeps each authorization, appeal, and records request on one governed case, with 42 CFR Part 2 obligations in view.
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Reviews follow the ASAM dimensions
Many payers review SUD levels of care against The ASAM Criteria, now in its fourth edition, or their own guidelines built on it. Packets and appeals are organized by the dimensions the reviewer actually scores, not rebuilt from the chart each time.
Concurrent review comes in short increments
Residential and withdrawal-management days are often approved a few at a time. Each review date, the days approved, and what the reviewer asked for stay on the case, so the next review starts where the last one ended.
Part 2 changes what can move
SUD records carry 42 CFR Part 2 protections beyond HIPAA. The 2024 final rule allows a single consent for treatment, payment, and health care operations, but records still move to a payer only with the consent the rule requires, so consent status sits on the case before anything is sent.
Denials arrive after the care was delivered
Medical-necessity denials on days already provided are appealed against the criteria the payer cited, with a checklist of the documentation that answers each point and the appeal deadline in view.
High-dollar claims draw records requests
When a payer or its contracted auditor asks for charts, the request gets a deadline, a response packet, and written questions about sampling and look-back before a sample becomes an extrapolated demand.
Parity belongs in the argument when it applies
Where a plan manages SUD care more strictly than comparable medical or surgical care, parity arguments belong in the appeal. They are added only where the facts support them.
Residential SUD · concurrent review · demo data
Human approval: Nothing reaches a payer without a named person’s approval, and SUD records move only with the consent Part 2 requires.