Admission & continuing auth
Secure initial authorization and track renewal dates across detox, residential, PHP, and IOP—before census outruns approved days.
Utilization review
Utilization review that extends authorized care
Cipher's UR specialists collaborate with your clinical team daily—securing authorizations, extending stays when medically necessary, and aligning documentation to the level of care you bill.
- Daily UR collaboration with clinical teams
- Authorization extensions & concurrent review
- Peer-to-peer assistance when payers challenge medical necessity
- 82% peer review approval rate
- 9-minute average eligibility turnaround (vs. 30-minute industry standard)
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Why Cipher
UR built for behavioral health census
Residential, PHP, and IOP programs live on authorization windows—not monthly billing cycles. When concurrent review lapses or documentation gaps appear mid-stay, claims stop paying while patients remain in care.
Cipher's daily utilization review collaboration—described in our onboarding Phase two materials—tracks expirations, escalates before auth lapses, and supports clinical documentation so billed program days match payer medical necessity rules.
What's included
How Cipher delivers
Concurrent review
Weekly and per-diem payer touchpoints aligned to your billed dates—so authorization stays active through the stay.
Clinical documentation support
Support treatment plans, progress notes, and level-of-care documentation before review windows close—not after denials arrive.
Peer-to-peer assistance
Peer-to-peer support when payers challenge medical necessity—aligned to the 82% peer review approval rate Cipher publishes on its homepage benchmarks.
LOC transition coordination
New authorization numbers when patients step between detox, residential, PHP, and IOP—preventing overlap denials.
UR reporting
Visibility into auth expirations, extension outcomes, and payer patterns affecting length of stay and cash flow.
Process
How it works
- 01
Map payer UR rules
Document each plan's concurrent review cadence, documentation requirements, and extension pathways during onboarding.
- 02
Align to census
Match UR calendars to billed program days—daily touchpoints for high-acuity residential and weekly cycles for PHP/IOP.
- 03
Escalate early
Engage payers before authorization expires—submitting clinical updates and extension requests with defensible documentation.
- 04
Close the loop with billing
Ensure auth numbers on claims match active approvals—UR and billing share one workflow, not separate silos.
Practices
Specialty billing by level of care
Services
Platform capabilities
FAQ
Utilization Review questions
What is utilization review in behavioral health billing?
Utilization review (UR) is the ongoing process of securing and maintaining payer authorization for treatment services—initial approval, concurrent review during the stay, and extensions when medical necessity supports continued care.
How is Cipher's UR different from clinical UR staff alone?
Cipher connects UR outcomes directly to billing—authorization numbers, billed dates, and documentation requirements stay synchronized so claims do not deny for auth lapses your clinical team thought were handled. Our UR specialists work with your clinical team daily, as described in our onboarding process.
Does Cipher support peer-to-peer reviews?
Yes. Behavioral health RCM includes peer-to-peer assistance when payers challenge medical necessity. Cipher coordinates clinical packet preparation and follow-up documentation to defend continued level of care.
What happens when a patient changes level of care?
A new authorization is typically required—even within the same agency. Cipher tracks LOC transitions and opens new auth workflows before billing codes change on the transition date.
How quickly does Cipher complete eligibility verification?
Cipher averages a 9-minute eligibility turnaround for benefits verification—compared to an industry-standard 30 minutes—supporting faster admission decisions alongside UR workflows.
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