Payer operations for behavioral health
Get paid for the care you already delivered.
Denial appeals, records requests, prior authorizations, and benefits verification in one governed work queue. The system drafts and tracks the work; a named person on your team approves every submission.
No patient information needed. Drafts back in 7 days.
Inside the case
What happens to your denial.
The letter becomes a case with an owner, a deadline, and an amount at risk. The payer’s notice is checked for procedural defects before anyone argues medicine, and the draft waits for a named person on your team.
Demo: a de-identified behavioral-health denial letter for 14 days of intensive outpatient care becomes a case with $6,500 at risk and an appeal due March 11. The payer’s notice is checked: it arrived on time with appeal rights, but it does not identify the criteria the payer relied on. The next step is to request those criteria in writing and draft the appeal, which waits for a named person’s approval.
Start with your hardest denials
See our work on your denials before you pay for anything.
A 2026 federal audit estimated 15.8% of one Medicaid plan’s behavioral-health prior-auth denials didn’t follow required process rules — mostly because no written notice was sent. We check for that before arguing medicine.
The workflow
One denial. Five completed steps.
Watch the same case move from denial to decision, with a named person approving before anything reaches the payer.
Log
Denial received · IOP · commercial plan
Reason: medical necessity not established
Appeal deadline tracked · $6,500 at risk
Check
Written notice: received on time
Stated reason and appeal rights: present
No procedural defect → argue criteria
Draft
Criteria cited: ASAM level 2.1
Evidence checklist: 5 items · 1 missing
Missing item routed to clinical lead
Approve
Reviewer: utilization review lead
2 edits · approved 3:12 PM
Auto-submission: never
Track
Submitted by staff via payer portal
Decision due in 30 days
Outcome and dollars logged to the case
Level-of-care authorization
Authorization packets that arrive complete.
Verification of benefits
Benefits verification your team can trace.
Every result includes its source, verification time, remaining uncertainty and next action.
Pricing
Pricing built around your payer workload.
Implementation is scoped after a workflow review. A paid pilot is available when you want proof before rollout.
Launch
From $2,500/month
- One site
- Governed case queue
- Prior authorization and VOB
- Denial appeal drafting
- Standard reporting
Growth
Most commonFrom $5,000/month
- Multiple sites
- Review and routing rules
- Integrations
- Advanced analytics
- Higher authorization volume
Enterprise
Custom
- Network-wide deployment
- SSO and custom security
- Credentialing workflows
- Dedicated implementation
FAQ
Direct answers for operators.
What do I send for the free appeal drafts?
A short worksheet, not documents: payer, plan type, state, level of care, the denial reason as written minus any patient facts, the month of service, and the amount rounded to the nearest $500. For a records request, the worksheet asks for the payer, charts requested, deadline, and look-back period. We never need a denial letter, a chart, or a name.
Does this replace our EHR?
No. Marsa Health coordinates the payer work that happens around the chart: prior authorizations, denial appeals, benefits verification, intake routing and credentialing. Structured records sync into the systems you already run.
Does the system make clinical decisions?
No. It prepares administrative work from approved sources and drafts payer documents. Clinical judgment, medical-necessity determinations and anything uncertain route to your staff, with the full context attached.
How does benefits verification work?
Insurance details are collected by secure link, checked against eligibility responses and payer portals, and consolidated into one record. Every value keeps its source, timestamp and confidence status.
What happens when the system is uncertain?
Uncertainty is routed, never smoothed over. Fields that cannot be confirmed are marked as needing confirmation and placed in a human review queue with a deadline. Nothing reaches a payer without a named human approving it.
Who approves what gets sent to a payer?
A named person on your team. Every packet, appeal and correction carries an approver and a timestamp, and nothing is submitted automatically.
Which behavioral-health systems can the platform integrate with?
We build against EHR and CRM, scheduling, phone and messaging, and eligibility sources. Named integrations are listed only once live and tested.
How long does implementation take?
A single-site pilot is typically configured in two to three weeks, including your payer mix, authorization requirements and review routing.
Is a business associate agreement available?
A BAA is part of the production deployment conversation. We can walk through the current agreement and security posture on a call.
How are substance-use treatment records handled?
Workflow design accounts for 42 CFR Part 2 sensitivity: consent flags, restricted fields and role-based access are part of the record model.
How is pricing calculated?
Pricing follows the operation: clinician count, monthly authorization and denial volume, and workflow scope. Not seats, not AI tokens.