Proprietary Claim Analytics
Identify pre-payment and post-payment opportunities on behavioral health claims—surfacing recoverable dollars generic billing vendors write off.
Revenue recovery
Negotiation That Recovers What You're Owed
Cipher pursues every dollar your contracts entitle you to—through proprietary pre-payment and post-payment claim negotiation, underpayment identification, and payer contract negotiation support tied to your behavioral health claims data.
- Proprietary pre- and post-payment claim negotiation
- Underpayment identification from EOB/ERA analysis
- Payer contract negotiation support
- 100% pre-payment review success
- Partners see up to 70% reimbursement increases through negotiation tactics
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Why Cipher
Negotiate Claims And Contracts From Your Billing Data
Cipher does not stop at claim submission. Our proprietary analytics identify pre-payment and post-payment opportunities to challenge underpaid or finalized claims—sometimes recovering up to 70% additional reimbursement, as we outline on our FAQ and onboarding materials.
During onboarding we audit accounts receivable, payments, and payer contracts alongside compliance and utilization review—so negotiation strategy reflects how your programs actually bill residential, PHP, IOP, detox, and outpatient services.
What's included
How Cipher Delivers
Pre- & Post-Payment Negotiation
Aggressive claim negotiation before and after payment—aligned to Cipher's Phase two onboarding model, not passive A/R reporting.
Payer Contract Negotiation Support
Support for leadership renegotiating payer terms—with claims data, denial trends, and reimbursement patterns from your census, not generic industry averages.
Underpayment Identification
EOB and ERA analysis flags allowed-amount gaps, contract mismatches, and systematic underpayments before they compound in A/R.
Rate & Reimbursement Monitoring
Track how contracted and out-of-network rates perform against expectations—Cipher averages 30.36% OON reimbursement with partners seeing higher returns through advanced negotiation tactics.
Appeals & Resubmission
When negotiation requires clinical documentation, Cipher ties appeals and systematic resubmission to the same workflow—97% medical appeal success rate on our RCM benchmarks.
Process
How It Works
- 01
Onboarding Audit
Comprehensive reviews of compliance, utilization review, accounts receivable, payments, and payer contracts—establishing a baseline before claims scale.
- 02
Identify Recoverable Dollars
Proprietary analytics flag underpayments, contract edit patterns, and finalized claims worth challenging—prioritized by payer and level of care.
- 03
Negotiate & Escalate
Pre-payment and post-payment negotiation on claims, with payer contract negotiation support when leadership pursues stronger terms.
- 04
Validate Collections
Confirm recovered amounts post to clean ledgers—variance reporting and A/R follow-up until negotiated dollars are collected or avenues are exhausted.
The Single-Case Agreement Pathway OON Revenue, Negotiated
When a patient needs your program and you're out-of-network, the single-case agreement (SCA) is the mechanism that gets the admission paid — a one-patient contract negotiated between the payer and your facility before or shortly after admission. SCAs are where out-of-network behavioral health revenue is actually decided: the negotiated rate, authorized days, and level-of-care terms in that agreement determine the entire financial outcome of the case.
Patient Needs Your Program
You're out-of-network — the admission needs a mechanism to get paid.
One-Patient Contract Negotiated
Rate, authorized days, and level-of-care terms set with the payer before or shortly after admission.
Admission Paid On Negotiated Terms
The SCA's terms decide the financial outcome — tracked through authorization, billing, and payment.
Effective SCA negotiation is clinical and financial at once. The payer's care manager needs medical-necessity justification for the level of care; your side needs a rate that reflects the actual cost of that care rather than the payer's opening offer. Cipher negotiates SCAs with claims data behind us — comparable rates, the patient's benefit structure, and the documentation payers require — and tracks the agreement through authorization, billing, and payment so the terms negotiated are the terms paid.
Underpaid-Claim Recovery Finding What Payers Owe
Underpayments are quieter than denials — the claim pays, just short. Contracted rates misapplied, fee-schedule updates not loaded, wrong reduction logic on per-diem claims: each instance is small, and across a year of claims they add up to material revenue. Most programs never catch them because nobody is comparing the remittance against the contracted rate line by line.
- Contracted rates misappliedpays short
- Fee-schedule updates not loadedpays short
- Wrong reduction logic on per-diem claimspays short
Cipher post-payment review: expected reimbursement vs actual payment, variances flagged, recovery pursued with the contract language attached.
Cipher's post-payment review does exactly that comparison: expected reimbursement per the contract versus actual payment, variances flagged, and recovery pursued through payer escalation with the contract language attached. The same analysis surfaces which payers underpay systematically — evidence that strengthens your position at the next contract renewal.
Fee-Schedule Analysis And Contract Support Before You Sign
Payer contracts in behavioral health are rarely negotiated from data — providers accept fee schedules without knowing how the rates compare to market, how the authorization terms will behave operationally, or which clauses (timely filing, recoupment windows, silent PPO language) will cost them later. Fee-schedule analysis changes that: your top codes priced against the proposed schedule, modeled against your payer mix, so you can see what the contract is worth before you sign it.
What gets modeled before you sign
Top codes priced against the proposed scheduleRates compared to marketAuthorization terms behaviorTimely filing clausesRecoupment windowsSilent PPO language
Cipher supports contract negotiation with the claims analytics your side of the table usually lacks — per-code rate comparisons, underpayment history with the payer, and the operational cost of their utilization review requirements. You negotiate with evidence instead of anecdotes.
Levels of Care
Specialty Billing By Level Of Care
FAQ
Contract Negotiations Questions
What does Cipher mean by contract negotiations?
Cipher combines payer contract negotiation support with proprietary pre-payment and post-payment claim negotiation. We challenge underpaid and finalized claims using analytics built for behavioral health—while helping leadership enter payer conversations with evidence from your actual reimbursement data.
Does Cipher negotiate payer contracts directly?
Cipher prepares data-driven negotiation materials and supports your leadership through payer contract negotiation. Final contract authority remains with your organization—we ensure you have behavioral health–specific claims evidence, not generic benchmarks.
What is proprietary post-payment negotiation?
After a claim is paid, Cipher's analytics can identify opportunities to challenge finalized claims for additional reimbursement. Our FAQ notes partners sometimes see up to 70% more through this post-negotiation process when documentation and payer rules support it.
How does this connect to denial management?
Denials, underpayments, and contract edits share root causes. Cipher pursues appeals, resubmission, and negotiation in one revenue cycle workflow—with 24-hour denial response on our RCM service benchmarks.
Who is my main point of contact at Cipher?
Every client receives a dedicated Partner Experience Executive—a named advocate for billing questions, reporting, and escalation—not a generic call-center queue.
Let's Discuss How We Can Optimize Your Revenue.
Schedule a complimentary revenue cycle analysis and identify opportunities to optimize your revenue
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