Behavioral Health Utilization Review

Reimagining UR through behavioral health innovation.

Pillars of Behavioral Health Utilization Review Success with Behavioral Health CareChain (BHCC)
Behavioral Health Utilization Review

Improve Behavioral Health Utilization Review Results

Today’s UR process for behavioral health needs improvement. Common barriers limit the success of your UR:

  • Inefficient manual workflow with limited time for call preparation.
  • Challenging team collaboration with missing and late documentation.
  • Staff burnout and high turnover.
  • High denial rates leading to premature patient discharges and unfunded days.
  • Lack of insight into opportunities for improvement.
  • Payor’s strict scrutiny and powerless negotiations.
  • Financial sustainability challenges.

But software automation provides a better way.

ARGO’s Behavioral Health CareChain (BHCC) automates the UR process and workflow to improve UR results, reduce denials, facilitate patient continuum of care with LOC transition tools, ensure compliance and regulatory readiness, and give leadership performance metric insights to make data-driven decisions for timely improvements.

Improve Operational Efficiency

The top three reasons for UR denials include insufficient evidence of medical necessity, missing documents, and scheduling issues. BHCC solves these problems.

Reducing denials starts with efficient call preparation. BHCC eliminates time- and labor-intensive manual searches for evidence of medical necessity by automatically gathering evidence and presenting it on a single, easy-to-read patient summary, where staff also have access to all relevant and important documentation and information. Call preparation with BHCC is 20x faster.

UR staff can determine ahead of time whether patients are at risk of authorization denial, allowing them to craft the best possible case. BHCC screens clinical documentation for medical necessity and diagnostic criteria to understand the probability of authorization. Staff can assess and compare these scores at a patient’s current level of care and hypothetical alternatives. This helps UR staff communicate with care teams to make stronger cases for consideration of a level of care transition to decrease the chances of denial and eliminate uncertainty for care teams.

With efficient call preparation and BHCC’s authorization screening, UR staff can proactively address challenging cases with care teams to obtain critical clinical documentation. Staff can then successfully obtain clinically justified care for patients. In the case of a peer review, BHCC can provide a streamlined case summary for providers, leading to higher success rates and authorizations.

Improve UR staff efficiency and productivity through a scaled process. Improved efficiency scales productivity during peak times. Flexible UR models support organizations of all sizes.

Utilization Review Task Efficiency: Comparison of task completion time between current UR processes and with Behavioral Health CareChain. Behavioral health UR operational efficiency.

Learn more: Unlock UR Operational Power

Improve Staff Performance and Retention

Learn more: Retain and Manage Great UR Talent

View Performance at a Glance

Understanding your UR department’s strengths and areas of opportunity is critical for success. BHCC allows leaders to easily identify and act on gaps leading to elevated staff and departmental performance.

BHCC allows leaders to leverage data to identify top performers and replicate what is working, strengthening team performance, improving patient outcomes, and driving overall success. Highlighting top performers not only boosts morale but also sets a standard of excellence that uplifts the entire department.

Keep Great Talent

Tight deadlines, missing documents, and manual searches for evidence are stressful. BHCC alleviates this administrative burden, so your staff feels prepared for calls and confident in the outcome.

When teams are empowered, supported, and equipped to succeed, they stay – and thrive.

Empower Collaboration

Improve coordination between care teams and UR staff to ensure patients receive the clinically appropriate length of stay. Alerts and notifications of tasks, pending deadlines, and missing documentation hold staff accountable. Patient information is continuously updated to ensure staff are effectively prepared for calls. UR staff and care teams can ensure the correct level of care by knowing if alternative levels are more likely to be approved.

Level of Care Steps

Improve Patient Care and Transition Management

Obtaining the necessary authorizations for the appropriate level of care directly supports successful patient discharges, which in turn reduces the likelihood of readmissions. As more patients complete treatment and achieve clinical stability, facilities see improved long-term outcomes that strengthen relationships with referral sources and community partners, reinforcing the facility’s reputation for quality care and recovery success.

BHCC screens and scores the strength of evidence of medical necessity for securing approval at the patient’s current level of care and for alternative care options. For instance, if a patient’s evidence score appears too low to qualify for an extension of the current LOC, step-down alternatives can be quickly and easily explored. Based on these predictive insights, doctors can make discharge or transfer decisions, and UR staff can communicate alternative care options with the care team.

Learn more: Improve Patient Care


Regulatory Compliance

Missing and late documentation is a leading cause of denials. BHCC continuously checks for missing and late documentation in the background. If identified, BHCC alerts clinical staff to document deadlines. With configurable criteria, facilities can get relevant, meaningful, and actionable data for success.

Optimize Financial Performance

Consistent economic sustainability and growth goals remain unrealistically optimistic without advancing UR operational best practices through automation. BHCC’s software automation improves UR processes and improves the facility’s economic outcomes.

Effective denial management directly strengthens an organization’s financial health by capturing revenue that would otherwise be lost. BHCC’s streamlined capturing of data and scoring of clinical documentation allows UR staff to obtain vital care for patients. This empowers facilities to maintain optimal bed occupancy, reduce early treatment discharges, and ensure smoother patient care. In turn, consistent and high-quality care builds a positive reputation with referral partners and the broader community, leading to increased admissions and long-term growth. BHCC equips facilities to realize revenue growth leading to sustained care for the patients behind their mission.

Financial performance in behavioral health isn’t just about cutting costs. It’s about working smarter across every stage of the care and billing process. By reducing insurance denials through proactive authorization management and accurate documentation, organizations can protect revenue that might otherwise be lost.   Ensuring smoother, more strategic transitions between levels of care helps align services with payor expectations, leading to better reimbursement rates and fewer unfunded days.

As your facility grows, so does the complexity of operations, but your costs do not have to. With BHCC, staff can work more efficiently, both within UR and across departments, reducing the administrative burden and minimizing the impact of overhead costs. At the same time, better data visibility supports faster decision making, patient throughput, and stronger revenue performance. The result? A healthier bottom line powered by operational efficiency and financial foresight.

Learn more: Strengthen Your Financial Sustainability

KPI BHCC Metric Charts

Expand Analytical Insights for Continuous Improvement

Continuously track and measure performance to identify opportunities for improvement. BHCC’s extensive key performance indicators (KPIs) allow you to detect issues, identify root causes, analyze trends, and monitor compliance. Data-driven decisions build success and confidence in these key areas.

Shed light on staff performance metrics, including timeliness and quality of documentation completion for process enhancement or identifying areas requiring additional training.

Monitor UR process performance and review denial trends by review type, insurance payor, and peer-to-peers to improve authorization outcomes. Understanding trends in denials, such as diagnostic criteria with the highest denials and patients’ denial histories, can help you and your staff craft more effective cases for medical necessity.

Stand firm with payors with real-time metrics. Compare payor denial rates with those of other payors with on-demand, easy-to-use charts. Examine trends and outliers or drill down into the details of denial rates so you can enter contract negotiations with information and confidence. Conversely, the identification of areas of concern or gaps by payors allows you to effectively advocate and obtain corrections and adjustments from payors.

With patient care at the forefront of everything you do in behavioral health, BHCC’s KPIs provide you with data to drive program and organization growth and development. For example, for a specific diagnosis, reviewing trends may warrant the development of a targeted program to better meet the needs of your patients.

Learn more: Drive Behavioral Health UR Success with KPIs

BHCC Achieves Quantifiable Results!

  • UR automation impacts your staff, financial sustainability, and patients by making the process more manageable, efficient, effective, and transparent, enabling continuous optimization.

  • Improved evidence of medical necessity precision and speed means greater efficiency, productivity, and performance results. In addition, it improves patient LOC planning with fewer premature patient discharges.

  • Better workflow automation improves team connection and collaboration. It also reduces stress and staff turnover while increasing staff lift capacity.

  • Financial optimization empowers the institution to focus on the mission of providing patient care.

  • Expanded management insights drive confident decision-making, stronger negotiations, better cases for medical necessity, and continuous process improvement.

Unlock patient, financial, and staff value with BHCC from ARGO!

Cost Revenue Impact Factors

Reimagining UR Through Behavioral Health Innovation

Behavioral Health CareChain (BHCC) automates the UR workflow to boost productivity, improve denial management, and measure valuable data for more confident decision-making. Watch this short video to learn how BHCC can positively impact your patients, staff, leadership, and entire behavioral health facility.

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Resources

Solution

Utilization Review Task Efficiency: Comparison of task completion time between current UR processes and with Behavioral Health CareChain. Behavioral health UR operational efficiency.

 

Unlock UR Operational Power

Solution

Reducing Denials 13 ways

Strengthen Your Financial Sustainability

Downloadable Brief

Next Generation Utilization Review Process for Behavioral Health

Next Generation Utilization Review Process for Behavioral Health