SERVICES

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

  • Thorough and timely approach to verifying insurance benefits, which results in increased admissions.
  • Dedicated team of professionals will walk you and your clients through understanding benefits, expected reimbursement and specifications of their policy.
  • Dedicated team of licensed behavioral health professionals complete initial requests to prove medical necessity for
    treatment being rendered.
  • Consistent and timely communication with clients and treatment providers regarding outcomes.
  • Licensed behavioral health professionals will continue to seek authorization for services during the course of treatment and communicate accordingly.
  • We will access your EMR and utilize our strong clinical background to put together the case for authorization versus asking your therapists to fill in “scripts” that take away from valuable treatment time.
  • SJHIA’s licensed behavioral health professionals will continue to advocate with your patient’s insurance company.
  • Our professionals complete these reviews in order to reduce the time you would take away from treatment and other important responsibilities.
  • Licensed behavioral health professionals will utilize their extensive experience in navigating the appeals process in order to advocate for authorization and reimbursement.
  • We will comprehensively evaluate your patient’s case including, but not limited to, reviewing current and prior medical records to determine the best course of action for appeal.
  • A team of dedicated billing professionals work diligently to submit and track claims throughout the entire process until claims adjudicate.
  • 24/7 access to specialized and customized billing software that allows you to understand the nuances of claims, design reports specific to your needs and succeed in maximizing 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 authorizations, 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 related to insurance.
Using SJHIA as your “in-house” insurance department allows our team to proactively contact your patients to address insurance related matters, which leads 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 client is assigned a licensed behavioral health professional who will call in the initial authorization, concurrent authorizations and appeals including Peer-to-Peer reviews.
  • Your assigned case manager will access your EMR and put together the case for authorization versus asking your therapists to fill in “scripts” that take away from 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.
  • Our dedicated Relationship Managers are always available to address any concerns.

Experienced Professionals On Every Case. Every Time.

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973.740.0023

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