SERVICES

BEHAVIORAL HEALTH

For most individuals, accessing the best behavioral health treatment is more about costs than what treatment works best. Insurance carriers are becoming increasingly more subjective in determining medical necessity for individuals. In turn, providers are being pulled away from treating their patients to arguing with insurance carriers for coverage of services.

SJ Health Insurance Advocates has a team of dedicated licensed behavioral health professionals that will work with your patients’ insurance carriers to allow for the best treatment to be authorized and reimbursed.

SERVICES

SJHIA works directly with clients of treatment facilities to verify and understand their benefits as it relates to the specific treatment being rendered. We have a dedicated team of professionals who will verify benefits by completing a thorough inquiry with the insurance company and detailing this information in an individualized template. SJHIA will also walk clients through understanding their benefits, their expected reimbursement and the specifications of their policy. SJHIA’s thorough and timely approach to verifying benefits often results in increased admissions and higher client satisfaction.
Entering treatment can often be a difficult and overwhelming experience. SJHIA completes initial authorization requests with insurance companies in a thorough and timely manner in order to set clients up for reimbursement success. Competent, fully licensed behavioral health professionals complete the initial authorization request to prove medical necessity for the specific treatment being rendered. SJHIA maintains consistent and timely communication with both clients and facilties. SJHIA differentiates itself by lead managing this process and allowing for the client and/or treatment facility to determine their level of involvement.
SJHIA continues to seek authorization and reimbursement through the duration of treatment. This includes concurrent authorizations with the insurance company to continue to prove medical necessity for the specific treatment being rendered. These reviews are performed by fully licensed behavioral health professionals who utilize their strong clinical background to advocate for the client’s treatment.
Insurance companies may begin to deny authorization at some point in the treatment process. SJHIA’s licensed behavioral health professionals advocate for additional approvals by performing a “Peer-to-Peer” review with the insurance company’s doctor. SJHIA is able to complete these reviews on behalf of the treatment facility due to the expertise and licensure of our staff.
Clients have the opportunity to engage SJHIA to complete appeals on their behalf. This may occur if treatment was never authorized or if treatment was denied in the authorization process. SJHIA will comprehensively evaluate your case, including but not limited to reviewing your medical records, in order to determine which appeal options may be the best fit. SJHIA employs licensed behavioral health professionals with extensive experience navigating the appeals process in order to advocate on behalf of the client.
SJHIA works to diligently generate and submit claims as well as track them throughout the entire claim adjudication process. SJHIA identifies issues immediately and works to resolve them in a timely fashion in order to have claims processed and paid as quickly as possible. Unique to SJHIA, we utilize software that allows for complete transparency and accountability into this process. Our billing software allows facilities to see exactly where and how claims are being processed and the work being done to have these claims processed. SJHIA employs a dedicated team of billing professionals that works specifically with you and for you: understanding the nuances of your claims, customizing reports designed specifically for you, and succeeding in maximizing your revenue.
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Advantages

Our ability to formulate a comprehensive clinical overview of your patients coupled with our licensed behavioral health professionals performing pre-authorization and concurrent authorization, including Peer to Peer appeals, allows your therapists the time to focus on treatment.

With SJHIA handling all insurance related matters, your staff will have more time to treat patients and focus on other business related activities.

Insurance is our area of expertise. Your team will not be put in the position to answer or resolve issues that arise related to insurance.

Using SJHIA as the “in-house” insurance department will allow for our team to proactively contact your patients to address insurance related matters which should lead to faster enrollment.  Additionally, with a Business Associate Agreement in place, the amount of documentation required to provide access to clinical documentation is reduced.

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Key Differentiators

  • Each Facility is assigned a licensed behavioral health professional that will personally be calling in for initial  authorization, concurrent authorizations and appeals including Peer to Peer appeals.
  • Your assigned licensed behavioral health professional will access your EMR and formulate the case for authorization versus asking your therapists to fill in “scripts” that take away valuable treatment time.
  • You as the Facility will have full reporting access to our billing platform 24/7.  You will see exactly when claims are submitted, how they were submitted and how they paid.

  • No term commitment. If you are not pleased with our work, you can terminate the Contract at any time.

  • We are always available to address any concerns.  Referrals upon request.

Experienced Professionals On Every Case. Every Time.

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973.740.0023

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