Behavioral Health Authorization

Stop losing revenue to insurance denials.

CriteriaIQ gives behavioral health treatment facilities and billing companies AI-powered tools to support medical necessity documentation, fight denials, and streamline utilization review.

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Time saved per auth

47m

Average time saved per authorization using CriteriaIQ versus manual criteria review.

Denial overturn rate

65%

Of denied behavioral health claims that are appealed are ultimately overturned — most facilities never appeal.

Analysis frameworks

ASAM, MCG, InterQual, and LOCUS analysis buttons covering every level of care and criteria framework.

Two Products. One Mission.

Built for how behavioral health
revenue cycle actually works.

Whether you need a Chrome extension for your Kipu EMR workflow or a full multi-tenant RCM platform, CriteriaIQ has you covered.

Chrome Extension — Works in Kipu EMR

Criteria Analyzer

AI-powered medical necessity analysis directly inside your Kipu EMR workflow. Scrapes the patient chart, analyzes against clinical criteria, and generates medical necessity documentation in under 60 seconds.

ASAM 4th Edition — all 6 levels of care
Milliman MCG — Residential, PHP & IOP
InterQual BH — Inpatient, PHP & IOP
LOCUS 4th Edition Assessment
Phone review scripts & appeal letters
Works on your existing Kipu account

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Full RCM Platform — Multi-Tenant

CriteriaIQ RCM

Complete utilization review management for behavioral health billing companies. Authorization tracking, eligibility verification, denial management, client portal, and Kipu EMR integration — all in one platform.

Authorization & concurrent review tracking
Denial management with appeal deadlines
Eligibility verification & VOB
Client portal for facilities
Analytics & AR aging reports
Kipu EMR sync & API webhooks

Why CriteriaIQ

Built by a UR professional.
For UR professionals.

20 years of behavioral health utilization review experience built into every feature. No generic healthcare software — purpose-built for how authorization actually works.

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ASAM 4th Edition

Complete subdimensional risk ratings and auth probability for all six ASAM levels of care. Initial and concurrent review.

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Milliman MCG

MCG criteria analysis for Residential, PHP, and IOP — both initial and concurrent. PHQ-9 and GAD-7 integrated automatically.

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InterQual BH

Full InterQual Behavioral Health criteria with explicit lettered sub-criterion citations. Inpatient, PHP, and IOP.

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LOCUS Assessment

All 7 LOCUS dimensions scored against 4th Edition criteria with composite score and level of care recommendation.

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Appeal Letters

Framework-specific appeal letters generated in one click from any analysis. Cites the exact criteria the payer used to deny.

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Kipu EMR Integration

Scrapes clinical documents, medications, assessments, and insurance data directly from the live Kipu patient chart.

Stop losing revenue to insurance denials.

Built for how behavioral healthrevenue cycle actually works.

Built by a UR professional.For UR professionals.

Start your 14-day free trial today.

Built for how behavioral health
revenue cycle actually works.

Built by a UR professional.
For UR professionals.