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 behavioral health professionals that can work with your patients’ insurance carriers to allow for the best treatment to be covered.

SERVICES

  • Verification of Benefits

  • Pre-Authorization of Services

  • Concurrent Utilization Review

  • Peer to Peer Reviews

  • Appeals

  • Claim generation, submission and tracking

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Advantages

Our ability to formulate a comprehensive clinical overview of your patients coupled with our team performing pre-authorization and concurrent reviews, including Peer to Peer calls, 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 client is assigned a licensed therapist that will personally be calling in the initial  authorization, concurrent authorizations and appeals including Peer to Peer calls.

  • 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 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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