For UR Directors & Revenue Cycle Managers in Behavioral Health

Faster authorizations, fewer denials — on the Kipu or BestNotes EMR you already run.

Name: CriteriaIQ RCM
Brand: CriteriaIQ

No migration, no chart re-entry — CriteriaIQ RCM layers UR, authorization tracking, and denial management on top of your existing chart.

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CriteriaIQ RCM authorization dashboard showing priority flags, review-due counts, and P2P and appeal status by patient

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.

In active pilot with behavioral health treatment facilities

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.

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

CriteriaIQ RCM analytics dashboard showing authorization outcomes, denial rate, peer-to-peer overturn rate, and breakdowns by payor, level of care, facility, and specialist

No Migration Required

Keep your Kipu or BestNotes EMR — no migration, no data move, no cash-flow gap. CriteriaIQ RCM layers on top of the chart your team already uses via API, independent of and not affiliated with Kipu.

✓ Syncs with Kipu EMR ✓ Syncs with BestNotes

Built and supported by Steven Cavan, in behavioral health utilization review since 2012 — not a support ticket queue. Read the story →

Built for UR teams and billing companies running authorization and denial workflows across a facility or multiple sites — not a fit for a solo private-practice therapist. Kipu and BestNotes sync out of the box; other EMRs with an API can typically be connected through a custom integration on request.

Platform Features

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

Built by utilization review specialists. Three things you won't find bundled together anywhere else — plus everything else you'd expect.

Why teams switch

⚕

Criteria Analyzer

AI-powered analysis against ASAM 4th Edition, Milliman MCG, and InterQual BH criteria. Generates phone review scripts and appeal letters.

Why teams switch

🔗

Kipu or BestNotes EMR Sync

Connect with your existing API credentials. Active patients sync directly into authorization records — no migration, no duplicate data entry.

Why teams switch

💳

Billing & AR, Built In

Track claim status, submission dates, payment, and aging across 0–90+ day buckets — in the same place as UR and denials, not a separate tool.

Also included

📋

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.

👁

Client Portal

Give facilities a read-only login to see their own patients' authorization status. No more calls asking for updates.

📊

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 →

Common Questions

Before you switch,
a few things to know.

Do I have to leave Kipu or BestNotes?

No. CriteriaIQ RCM connects to your existing Kipu or BestNotes EMR via API sync — it's a layer on top of your current system, not a replacement. Patient data syncs in automatically; there's no chart migration and no disruption to clinical workflows already running in your EMR.

What happens to my data if I cancel?

Per our Business Associate Agreement, all PHI is returned or destroyed within 30 days of termination, with written confirmation available on request. You can cancel a monthly plan anytime through your account settings, with access continuing through the end of the current billing period.

Who supports me?

Direct support from the CriteriaIQ team at support@criteriaiq.com — built and supported by someone who's worked utilization review since 2012, not a ticket queue. Enterprise and White-Label plans include priority support and a dedicated support line.

What happens if the company grows or changes hands?

Your data is portable on demand under the BAA, with nightly automated backups and full PHI return or destruction within 30 days of termination. The platform runs on redundant cloud infrastructure, and API webhooks mean your workflows are never locked to a single person's screen. Enterprise and White-Label plans carry a same-business-day support response commitment.

Is CriteriaIQ RCM right for me?

It's built for UR teams and billing companies running authorization, denial, and billing workflows across a facility or multiple sites. It's not built for a solo private-practice therapist tracking a handful of clients. Kipu and BestNotes sync out of the box; if you're on a different EMR with an API, we can usually build a custom integration on request.

Security & Compliance

The compliance basics,
actually in place.

Not a trust badge graphic — here's exactly what's signed, backed up, and supported today.

In place before you sync

📄

Business Associate Agreement

A signed BAA is in place before any PHI syncs from your EMR. Per its terms, all PHI is returned or destroyed within 30 days of termination, with written confirmation available on request. Read the BAA →

Your data, your control

💾

Portable by Design

Nightly automated backups and redundant cloud infrastructure. Data is portable on demand under the BAA — your workflows are never locked to a single person's screen.

Direct, not a ticket queue

🩺

Support From Someone Who's Done This

Built and supported by Steven Cavan, in behavioral health utilization review since 2012. Enterprise and White-Label plans include a same-business-day support response commitment. Read the story →

🔗 Integrates with Kipu EMR — API Sync Verified Direct API sync, independent of and not affiliated with Kipu.

Pricing

Straightforward pricing.
No surprises.

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

Every competitor makes you request a demo. We publish our prices — start today, no sales call.

Monthly

Annual Save 15%

UR Starter

$254

per month, billed annually

Less than the cost of one denied claim going unappealed.

Up to 2 specialists
1 facility
Authorization tracking
Denial management
Email notifications

Start Free Trial

✓ Recommended — Most Popular

Professional — UR teams up to 5

$1,104

per month, billed annually

Less than a part-time biller's salary — with more coverage.

Up to 5 specialists
3 facilities
Client portal
Kipu or BestNotes EMR sync
API webhooks
Analytics dashboard

Start Free Trial

Enterprise — Multi-Facility Operators

$2,549

per month, billed annually

A fraction of one FTE's salary, covering unlimited specialists.

Unlimited specialists
Unlimited facilities
Criteria Analyzer included
Priority support
Custom onboarding

Start Free Trial

White-Label

$4,249

per month, billed annually

One resold client covers the month.

Your brand, your domain
Everything in Enterprise
Resell to your clients
Dedicated support
Custom contract

Start Free Trial

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

On a different EMR? Kipu and BestNotes sync out of the box — most other behavioral health EMRs with an API can be connected through a custom integration on request. Ask us about yours →

	UR Starter	Professional UR teams up to 5	Enterprise Multi-facility operators	White-Label
Specialists	Up to 2	Up to 5	Unlimited	Unlimited
Facilities	1	3	Unlimited	Unlimited
Authorization tracking	✓	✓	✓	✓
Denial management	✓	✓	✓	✓
Client portal	—	✓	✓	✓
Kipu / BestNotes EMR sync	—	✓	✓	✓
API webhooks	—	✓	✓	✓
Analytics dashboard	—	✓	✓	✓
Criteria Analyzer included	—	—	✓	✓
White-label / resell	—	—	—	✓

Faster authorizations, fewer denials — on the Kipu or BestNotes EMR you already run.

Revenue cycle managementfor behavioral health is broken.

CriteriaIQ RCM changes this.

The platform in action.

Never miss another authorization deadline.

Turn denials into revenue recovery.

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

Three tools. One platform.

Before you switch,a few things to know.

The compliance basics,actually in place.

Straightforward pricing.No surprises.

See CriteriaIQ RCM in action.

Revenue cycle management
for behavioral health is broken.

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

Before you switch,
a few things to know.

The compliance basics,
actually in place.

Straightforward pricing.
No surprises.