Mental Health

Prior authorization in mental health directly affects access to care, continuity of treatment, and practice revenue stability. It’s not just paperwork. Behavioral health providers face a unique mix of recurring authorizations, medical necessity reviews, utilization management rules, and inconsistent payer requirements. Unlike one-time surgical approvals, mental health services often require ongoing authorization extensions, sometimes every […]

The 2026 CMS Physician Fee Schedule (PFS) now establishes a new foundation that redefines how tele-mental health services are delivered, documented, and reimbursed. This shift is not incremental; it represents a fundamental redesign of federal telehealth expectations. Key policies such as home-based telehealth reimbursement at non-facility rates, audio-only parity for behavioral health, permanent removal of […]

Prior authorization is where revenue leaks and treatment stalls, not because payers are impossible, but because processes are inconsistent. When teams guess whether today’s 90837 needs PA for a specific plan, or submit a renewal without current scores, reviewers hesitate and denials climb. The cure is a boring, repeatable machine that runs the same way […]