Downcoded sessions and denied admissions cost behavioral health recoverable revenue every day.
Behavioral health revenue lives in high-volume time-based sessions and high-stakes level-of-care stays, time-tier downcoding, missing E/M add-ons, concurrent-review lapses, and MAT/OTP frequency edits. Manual billing teams catch a fraction of the errors. Ember catches all of them.
Trusted by specialty groups and health systems
Where behavioral health revenue leaks
The denial patterns Ember was built for
Behavioral health revenue lives in high-volume time-based sessions and high-stakes level-of-care stays, and each carries its own denial trap. Downcoding, concurrent-review lapses, and frequency edits compound into systematic underpayment. Ember closes each gap.
01 · Psychotherapy time & add-ons
Sessions downcoded and E/M psychotherapy add-ons dropped.
Time-based psychotherapy pays by documented face-to-face minutes, but 90837 routinely gets downcoded to 90834, and the add-on psychotherapy code that pairs with an E/M visit is left off entirely. Each error is small per session and enormous across a full panel. Ember reads documented time and pairs the right add-on before submission.
90832 · 90834 · 90837 · 9083802 · Level-of-care auth & review
Authorized IOP, PHP, and residential stays denied mid-treatment.
Higher levels of care require prior authorization and continued-stay (concurrent) review against shifting medical-necessity criteria. A missed continued-stay deadline or a documentation gap turns an authorized admission into a denied stay after the care is delivered. Ember secures auth, tracks review deadlines, and builds the appeal when denials occur.
H0015 · S9480 · 0906 · 9079103 · MAT & OTP bundling
Frequency and bundling edits on medication-assisted and OTP services.
Medication-assisted treatment and opioid treatment program billing carries weekly bundled G-codes, drug administration codes, and strict frequency rules that differ by payer. Errors in bundling or frequency generate denials across recurring addiction-medicine claims. Ember validates codes and frequency against each payer's current policy before the claim submits.
G2067 · G2068 · H0020 · J0571Three engines.
One source of truth.
Ember connects clinical documentation, payer policy, and contract terms into a single intelligence layer. Built for the time-based sessions, telehealth rules, and level-of-care reviews behavioral health billing requires.
01 · Foundation
Data Engine
Bridges the clinical and the financial. Unifies documentation, coding decisions, payer policy, and contracts across every session, admission, and provider.
T. Brooks
Session #B-70244
02 · Audit
Coding Engine
Reviews 100% of sessions and encounters against national standards, payer-specific policies, your internal guidelines, and your payer contracts. Every flag carries a rule citation.
Code 90837 — 53 min supports 60-min tier
CPT time rules · confidence 0.96
03 · Recovery
Appeal Engine
Reads CARC and RARC codes, identifies the applicable medical-necessity policy and contract terms, drafts the appeal letter, packages documentation, and tracks every claim to adjudication.
Re: Claim #B-70244 · Denial CO-50
Partial hospitalization meets medical-necessity criteria under LCD L34520: documented acuity and failed lower level of care, per contract §2.1…
Audit upstream.
Appeal downstream.
Two workflows do most of the work for behavioral health practices. The first prevents denials before they happen. The second recovers the ones that slip through.
Pre-bill audit
Catch the downcoded session before the claim leaves.
Ember reviews every session against coding standards, payer behavioral policy, and your contracts. Time-tier downcoding, missing add-ons, telehealth modifiers, and level-of-care auth gaps are flagged before submission.
- 1
Ingest the encounter
Pulls session notes, documented time, treatment plans, and level-of-care records from your EHR and practice management system.
- 2
Validate against rules
Checks psychotherapy time tiers and E/M add-ons, telehealth modifiers, MAT/OTP frequency, and level-of-care auth status against each payer's specific policies.
- 3
Recommend with citation
Returns the suggested correction tied to the exact payer policy, coding rule, or contract term.
- 4
Educate the provider
Coding patterns drive clinician-level coaching, so session documentation and time capture improve across every provider.
Recode 90837 + add 90833 — time supports both
CPT time rules · confidence 0.97
+23%
Clean-claim rate
100%
Encounters reviewed
+5%
Net collection rate
Automated appeals
Pull. Review. Push.
When a denial occurs, Ember identifies the root cause, retrieves session notes, treatment plans, and concurrent-review records, references payer medical-necessity policy and contract terms, drafts the appeal, and tracks it through adjudication.
Level-of-care necessity
Frequency exceeded
Add-on bundled
Auth not on file
PHP stay appeal
-57%
Denial rate
-45%
Cost to collect
+9.3%
Net revenue per visit
The full revenue cycle
From eligibility to adjudication. Covered.
Audit and appeals are the workhorses, but Ember protects behavioral health revenue at every stage of the cycle.
Eligibility Verification
Confirms active coverage and behavioral benefit structure before the visit, and flags telehealth and level-of-care coverage gaps before they become billing problems.
Prior Auth & Concurrent Review
Secures authorization for IOP, PHP, and residential admissions, generates the clinical documentation payers require, and tracks continued-stay review deadlines automatically.
AI Medical Coding
Reviews 100% of sessions, time-based psychotherapy, E/M add-ons, MAT/OTP, and telehealth, against national standards and payer rules before claims submit.
Pre-bill Audit
Predicts and prevents denials before claims go out, catching time-tier downcoding, missing add-ons, and frequency-edit issues before they generate write-offs.
Denial Management
Full appeal lifecycle for every behavioral denial type, level-of-care necessity, frequency edit, bundling, and auth failure, tracked to adjudication.
Underpayment Recovery
Parses contracts to model what each session, admission, and MAT claim should pay, then surfaces line-item underpayments at scale.
Session and level-of-care revenue, recovered
-57%
denial rate
-45%
cost to collect
100%
encounters audited
3 days
to first results
Based on Ember AI benchmarks across customer practices. Results vary by payer mix and specialty.
Frequently asked questions
Everything you need to know about how Ember fits into your revenue cycle.
- 50-75% reduction in FTE hours
- Faster cash acceleration
- Prevent 55%+ of denials
We provide ROI benchmarks and dashboards so you can track outcomes from day one.
See what your behavioral health practice is leaving on the table
Bring us 30 days of denial data. We'll show you where the revenue is and exactly how Ember would recover it.