CriteriaIQ UR Platform

Complete revenue cycle
management for behavioral health.

Authorization tracking, VOB documentation, denial management, billing & AR, client portal, and Kipu EMR sync — all in one platform built for how your UR team actually works.

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How it Works

From admission to payment,
every step covered.

CriteriaIQ UR manages the full revenue cycle workflow from initial authorization request to final payment — with alerts at every critical point.

01
Verify & Authorize
Check eligibility, document benefits, and submit the initial authorization request. Kipu EMR data syncs automatically.
02
Track & Review
Concurrent review reminders fire before auth windows close. P2P scheduling and appeal management built in.
03
Manage Denials
Categorize denials by reason and code, track appeal deadlines, assign to specialists, and document outcomes.
04
Bill & Collect
Track claim status, submission dates, EOBs, and AR aging. Webhook API pushes updates to your billing system in real time.
Features

Built for the details
that cost you money.

Authorization dashboard
shows everything at a glance.

Your entire caseload in one view. See which authorizations are expiring soon, which reviews are due today, and which cases need immediate attention — without opening a single spreadsheet.

  • Priority case alerts — Red flags for auths past end date with no concurrent review scheduled
  • Days remaining counters — Visual indicators showing exactly how many days until each auth expires
  • Status color coding — Green for authorized, amber for review due, red for expiring soon
  • One-click actions — Schedule P2P, request extension, or start appeal directly from the dashboard
📊
Live Authorization Dashboard
Real-time view of all authorization statuses, review deadlines, and priority cases across all your facilities.

VOB verification with
complete documentation.

Verify eligibility and benefits in seconds. Document coverage dates, deductibles, OOP maximums, copays, and network status — all linked directly to the authorization record for audit compliance.

  • Real-time eligibility checks — Instant verification through payor portals and clearinghouses
  • Benefit breakdown capture — Document deductibles, OOP max, coinsurance, copays, and coverage limits
  • Network status tracking — In-network vs out-of-network provider verification with effective dates
  • Audit-ready documentation — Full VOB records attached to each auth with timestamps and source verification
✅
VOB Verification System
Complete eligibility verification with benefit documentation, coverage limits, and network status tracking.

Billing & AR management
with automated tracking.

Monitor claims from submission to payment. Track claim status, submission dates, rejection reasons, and AR aging buckets — with automatic alerts for claims approaching timely filing deadlines.

  • Claims status dashboard — Real-time view of submitted, pending, paid, and denied claims by facility and date
  • AR aging buckets — Automatic categorization into 0-30, 31-60, 61-90, and 90+ day aging buckets
  • Timely filing alerts — Automated warnings before claims hit payor filing deadlines (95 days, 1 year, etc.)
  • Payment posting integration — Webhook API updates claim status when EOBs are processed in your billing system
💳
Billing & AR Dashboard
Complete accounts receivable tracking with aging buckets, payment status, and timely filing deadline management.

Denial management with
structured workflows.

When a claim is denied, CriteriaIQ UR activates a step-by-step workflow. Categorize by CARC/RARC code, set appeal deadlines, assign to specialists, and track through to resolution — no more lost appeals.

  • 13 denial categories — Medical necessity, timely filing, authorization issues, and more with CARC/RARC tracking
  • Appeal deadline tracking — Visual countdown timers ensure you never miss a deadline
  • Automated assignments — Route denials to the right specialist based on denial type and facility
  • Overturn analytics — Track success rates by payor, facility, and denial reason to identify patterns
⚖️
Denial Management Workflow
Step-by-step process for categorizing denials, tracking appeal deadlines, and measuring overturn success rates.

Client portal gives facilities
real-time visibility.

Stop fielding "what's the status?" phone calls. Each facility gets their own branded login to see their patients' authorization statuses, review schedules, and billing updates in real time.

  • Facility-scoped access — Each portal user only sees their own facility's patients, ensuring privacy
  • Real-time status updates — Authorization dates, assigned specialist, and next review automatically sync
  • White-label branding — Portal displays your company logo and colors, not CriteriaIQ
  • Reduces call volume by 70% — Facilities check status themselves instead of calling your team
👁‍🗨
Facility Client Portal
Read-only portal for treatment facilities to check their patients' authorization statuses without calling your team.

Kipu EMR integration
eliminates duplicate data entry.

Connect your Kipu EMR credentials once, and active patients automatically sync into authorization records. Patient demographics, admit dates, and level of care populate instantly — no more manual typing.

  • One-click patient sync — Active Kipu patients appear in CriteriaIQ with full demographics pre-filled
  • Secure API connection — Uses your facility's own Kipu API credentials, encrypted and stored per tenant
  • Real-time updates — LOC changes and discharge dates sync automatically from Kipu to your auth records
  • Saves 15+ minutes per auth — No more copying patient data between systems or verifying spelling
🔗
Kipu EMR Integration
Direct connection to Kipu EMR pulls patient data automatically, eliminating manual data entry and errors.
Get Started

Ready to see it
for yourself?

30 minutes. No pitch deck. Just the platform and a live walkthrough with a product specialist.

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