Built by someone who knows
the real problems.

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

But solving documentation was just the beginning. As I worked with more billing companies and treatment facilities, I realized the problem was much bigger than medical necessity analysis. The entire revenue cycle was broken — from eligibility verification to final payment collection.

I hope you and your team find the value in this platform. 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.

But more than that, it was built for the billing specialist manually tracking 200 authorizations in Excel. The denial manager who knows there's money being left on the table but can't prove it. The facility administrator fielding 20 phone calls a day asking for status updates.

The goal has always been simple: make the documentation reflect the clinical reality, and make the business process support the clinical mission. When both work together, patients get the care they need and facilities get paid for providing it. That's the whole point.

Every feature in CriteriaIQ RCM solves a real problem I've encountered in the field. Every workflow maps to how UR teams actually work. Every integration addresses a pain point that costs time, money, or patient care quality.

This is what behavioral health revenue cycle management should look like. Finally.