Behavioral Health Revenue Cycle

Stop losing revenue
to denials.

CriteriaIQ RCM gives behavioral health billing companies and treatment facilities one platform to manage utilization review, track authorizations, and fight back against insurance denials.

Schedule a Demo See how it works →
The denial problem
$260B
Lost annually to claim denials across U.S. healthcare. Behavioral health bears a disproportionate share.
Average overturn rate
65%
Of denied behavioral health claims that are appealed are ultimately overturned — most facilities never appeal.
Time lost to manual UR
11 hrs
Per week per specialist spent on manual tracking, phone calls, and authorization paperwork.
The Problem

Revenue cycle management
for behavioral health is broken.

  • ✗
    Authorizations tracked in spreadsheets
    Review dates missed. Auth numbers lost. No visibility into which cases are at risk until it's too late.
  • ✗
    Denials managed reactively
    By the time a denial arrives, the clinical documentation window has closed and the appeal window is ticking.
  • ✗
    No single source of truth
    Billing, UR, and clinical teams work in silos. Information lives in email threads and sticky notes.
  • ✗
    Insurance criteria changes constantly
    ASAM, MCG, InterQual, and payor-specific criteria evolve. Manual reviews can't keep up.

CriteriaIQ RCM changes this.

One platform connects your utilization review, eligibility verification, billing, and denial management workflows. Built specifically for how behavioral health revenue cycle actually works.

  • AI-assisted medical necessity analysis against ASAM, MCG, and InterQual criteria
  • Automated review reminders before authorization windows close
  • Structured denial tracking with appeal deadline management
  • Client portal so facilities see their own auth status in real time
  • Webhook API to connect with your existing billing systems
  • Kipu EMR integration — sync patients directly, no manual entry
See it in Action

The platform in action.

Real screenshots of the CriteriaIQ RCM platform managing authorizations, tracking denials, and connecting with Kipu EMR.

📊
Authorization Dashboard
Live view of all authorization statuses with priority alerts and deadline tracking.

Never miss another authorization deadline.

Priority alerts flag cases that need immediate attention. Visual countdown timers show exactly how many days remain on each authorization.

  • → Red flags for expiring authorizations
  • → One-click P2P scheduling
  • → Complete audit trail

Turn denials into revenue recovery.

Structured denial workflow with CARC/RARC tracking, appeal deadline management, and specialist assignments. Track overturn rates by payor and facility.

  • → 13 denial categories with code tracking
  • → Appeal deadline countdown timers
  • → Overturn rate analytics
⚖️
Denial Management
Systematic appeal workflow with deadline tracking and success rate analytics.
Platform Features

Everything your UR team needs,
nothing they don't.

Built by utilization review specialists. Every feature solves a real workflow problem.

⚕
Criteria Analyzer
AI-powered analysis against ASAM 4th Edition, Milliman MCG, and InterQual BH criteria. Generates phone review scripts and appeal letters.
📋
Authorization Tracking
Every authorization in one place. Concurrent review scheduling, P2P tracking, appeal management, and automated reminders.
✓
Eligibility Verification
Document eligibility checks with coverage dates, deductibles, OOP maximums, and network status — all linked to the authorization record.
💳
Billing & AR
Track claim status, submission dates, payment, and aging across 0–90+ day buckets. Denial workflow with CARC/RARC coding built in.
👁
Client Portal
Give facilities a read-only login to see their own patients' authorization status. No more calls asking for updates.
🔗
Kipu EMR Sync
Connect to Kipu EMR with your API credentials. Active patients sync directly into authorization records — no duplicate data entry.
📊
Analytics & Metrics
Authorization approval rates, denial trends, AR aging, and specialist performance — filterable by date, facility, and payor.
🔔
Smart Notifications
In-app and email alerts for review due dates, expiring authorizations, and priority cases — before revenue is at risk.
🏷
White-Label Ready
Resell CriteriaIQ RCM under your own brand. Custom logo, colors, and domain. Your platform, your clients.
Products

Three tools. One platform.

CriteriaIQ RCM brings together your utilization review, criteria analysis, and billing workflows under one roof.

UR Platform
CriteriaIQ UR
Multi-tenant utilization review management. Authorization tracking, concurrent reviews, denial management, billing, client portal, and Kipu integration.
Learn more →
AI Analysis Tool
Criteria Analyzer
Chrome extension for Kipu EMR. Analyzes patient charts against ASAM, MCG, and InterQual criteria in seconds. Generates phone scripts and appeal letters.
Learn more →
Coming Soon
CriteriaIQ Connect
Real-time eligibility verification, claims status, and payor connectivity — integrated directly into your UR workflow without switching systems.
Join waitlist →
Pricing

Straightforward pricing.
No surprises.

All plans include unlimited authorizations, document storage, and email notifications. Annual billing saves 15%.

Starter
$499
per month
  • Up to 2 specialists
  • 1 facility
  • Authorization tracking
  • Denial management
  • Email notifications
Get started
Professional
$1,299
per month
  • Up to 5 specialists
  • 3 facilities
  • Client portal
  • Kipu EMR sync
  • API webhooks
  • Analytics dashboard
Get started
Enterprise
$2,999
per month
  • Unlimited specialists
  • Unlimited facilities
  • Criteria Analyzer included
  • Priority support
  • Custom onboarding
Contact sales
White-Label
$4,999
per month
  • Your brand, your domain
  • Everything in Enterprise
  • Resell to your clients
  • Dedicated support
  • Custom contract
Contact sales

Add-ons: +$99/mo per additional specialist · +$99/mo per additional facility · +$299/mo Criteria Analyzer (standalone)

Ready to stop losing revenue?

See CriteriaIQ RCM in action.

Schedule a 30-minute demo with a product specialist. No pitch deck — just the platform.

Schedule a Demo
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