Built by a clinician.
For clinicians.

I have worked in behavioral health since 2004 — starting in direct client care, then moving through management and operations, and into utilization review full-time since 2012. Over those years I've held a BA in Applied Clinical Psychology from Florida Institute of Technology and an MS in Information Assurance and Cybersecurity with dual specializations in Network Defense and Digital Forensics from Capella University.

I have always strived to make patient care more productive. But one problem kept coming up, year after year, across every facility I worked with: the lack of medical necessity understanding amongst clinical teams has always posed problems in utilization review — particularly when determining appropriate lengths of stay and improving clinical documentation to meet criteria points.

Facilities were losing authorizations not because patients didn't clinically need the care, but because the documentation didn't speak the language that insurance reviewers are trained to look for. Progress notes that didn't cite dimensional drivers. Service Request Forms filled out generically. Concurrent reviews that couldn't demonstrate why step-down was premature. These are fixable problems — and they were costing patients days, sometimes weeks, of treatment they needed.

So I decided to do my own research based on the criteria to build this tool.

"If criteria is not met, it will tell you why — and exactly what areas to improve on to make sure you get that insurance authorization."

CriteriaIQ uses the current clinical documentation from the patient's chart. It reads what your team has actually documented — not what you intended to document. That's the most honest feedback a UR clinician can get before submitting to a payer.

The initial Service Request Forms and concurrent review forms are built straight from ASAM 4th Edition criteria — the same edition your payers are using. Every subdimensional risk rating, every authorization probability score, every dimensional treatment plan maps directly back to the published criteria.

This tool should be used as a guide. It is a documentation and decision-support tool — not a replacement for clinical judgment. Every output requires review by a licensed clinician before submission. But as a guide, it will save your team hours of work and lead to longer, more justified lengths of stay for each patient in your care.

I hope you and your team find the value in this tool. It was built for you — the UR coordinator staying late to finish concurrent reviews, the clinical director coaching staff on documentation, the nurse trying to explain to a medical director why a patient still needs residential care.

The goal has always been simple: make the documentation reflect the clinical reality. When it does, patients get the care they need. That's the whole point.