Custom agents for behavioral health operations
We build the agent, connect it to your EHR and the payer portals, and run it beside your team until it stops being wrong. Then it runs every day and reports what it did. The denial engine on this site is one of them, built the same way.
What we build.
Six workflows a behavioral health facility runs by hand and should not have to
Benefits and eligibility
Verifies benefits on every inquiry, pulls the plan's behavioral health terms, deductible, and out-of-pocket position, and flags an out-of-network plan before admission instead of after the first claim comes back.
Authorization and concurrent review
Watches every authorization end date, drafts the concurrent review packet from the chart against the payer's own medical-necessity policy and ASAM level-of-care criteria, and puts it in front of your utilization review clinician while the window is open.
Denial and appeal
Reads 835s and denial letters, scores which denials are worth fighting, writes each appeal from the record, and tracks every filing to a decision. This is the engine the rest of this site describes.
Remit posting and underpayment
Posts remits, compares every paid line against the contracted or expected rate, and separates a short payment from a denial, so the short payments stop passing as paid.
Documentation and chart audit
Checks notes against payer and state requirements before the claim goes out: an unsigned note, a missing level-of-care justification, a group note that names the wrong participants.
Census and hours
Counts attended hours per patient per week against the level of care being billed and raises the ones that fall short, without naming a patient in the alert.
How it gets built.
One workflow at a time, watched before it is trusted
Map one workflow
We sit with whoever does the work today and write down every step, every system they open, and every judgment call they make. That document is the specification, and you keep it whether or not we build anything.
Connect read only
The agent starts with read access to your EHR, your clearinghouse, and the payer portals. It watches and reports for as long as it takes to trust, before it is allowed to write anything anywhere.
Run it beside your team
Its output goes to a person who checks it against real cases, not test data. We fix what it gets wrong until the corrections stop.
Put it on a schedule
It runs on its own each day and reports what it did, what it skipped, and why. When it is unsure, it stops and asks rather than guessing.
Where the line is.
An agent handling patient records has to be boring about it
A signed BAA before any record
We sign a Business Associate Agreement before touching a single record, hold SUD records to 42 CFR Part 2, and work under minimum-necessary access controls. This describes how we operate and is not legal advice.
A human tap before anything external
No agent files an appeal, submits a claim, posts a payment, or sends an email on its own. Every outbound action queues for approval from your team and logs who approved it.
Arithmetic is code, not a language model
Dollar amounts, day counts, filing deadlines, and eligibility rules are computed in deterministic code. The model writes the English. That is why the numbers do not drift between runs.
Every run leaves a trail
What ran, what it read, what it changed, and what it queued, kept per run. When a payer or an auditor asks how something was produced, the answer is on file.
Your records train nothing
Your records are used to do your work and nothing else. They are not used to train a model, and they are not pooled with another facility's data.
Common questions.