Services for Providers

National and regional providers look to BHM for many benefits, like increasing access to behavioral health expertise, smoothing erratic workforce needs, and trusting in our delegation services. Financial challenges and revenue cycle management concerns distract attention from providing high-quality patient care. BHM offers enhanced review services matching the changing needs of care systems. Choosing BHM:

  • Saves Money. We Do More For Less.
  • Ensures Meeting Turnaround Times. We Have The Right People, Processes, and Programs.
  • Leverages Subject Matter Experts for Complex Cases. We are Connected To Reviewers You Need.
  • Streamlines Your NCQA Renewal Process. BHM is NCQA/UM Accredited.

Providers, hospitals, and health systems wanting new levels of efficiency, like you, see us as key to raising their day-to-day operations.

Physician advisor

Peer Review Services

Since 2002, we supplement your utilization management process by­­­ providing medical director administrative expertise.

Our network of peer reviewers assess clinical information/documentation received in the provider service request, and, on a case-by-case basis, decide if the health care services requested from the providers are appropriate and should be paid.

We do this accurately, transparently, and in a very cost-effective ways.

Build Your Piece of Mind
BHM meets industry quality standards. NCQA-Accredited programs are eligible for automatic credit when they work with another NCQA-Accredited organizations.

Validating completeness of every request and synthesizing clinical notes BEFORE reviewer assignment means reviews based on accurate and complete records.

Integrating into the medical necessity review process or improving your denial management metrics, BHM’s network of reviewers gives you the edge..

You remain in compliance with your accreditation standards and regulatory requirements.

Clients use trend reports for identifying patterns, including red alerts and potential problem identification, to help uncover potential improvement and training opportunities for their team.

Imagine your complex cases processed as easily and as accurately as your most typical requests.

That’s the BHM difference.

BHM’s network spans the US with hands-on knowledge of CMS procedures and regulations. As needs change, the network evolves; meeting tomorrow’s demands.

BHM review services enhance your processes, not rebuild them.

The right tool for the right job means BHM recommends options addressing the pitch points in your reimbursement processing system. Our nimble on-boarding supports emergent opportunities.

Reach out to one of our client advisers. Ask how flexible behavioral health and medical expertise can be. Serving your needs with:

  • Traditional, 3rd party medical necessity reviews

  • Quality of care audits and denial management

  • Treatment Plan Assessment, including lengths of stay, levels of care, and medication review

  • Medical Director oversight for compliance requirements

  • Specialty consultations, including SUD, addictionology, ABA/Autism, and Psychological testing

Compliance requirements:

NCQA, URAC, and some state utilization review criteria set operational standards for your organization. An On-Demand Medical Director focused on your unique needs can give flexibility to the staff budgeting line item.

Transition Staffing:

While HR recruits the next medical director, productivity begins to fluctuate. Bringing in a transitional medical director stabilizes output and settles any angst the change of a key staff position creates.

Behavioral health (BH) care presents a particular challenge due to the shortage of trained professionals combined with the growing demand for services.

From the beginning, BHM focused on meeting of BH specialty consulting needs of Substance Use Disorder, Addictionology, ABA/Autism, Psychological Testing.

Complex care or treatment plans pull case information from multiple sources, and can benefit from medical director review from the “big picture” point of view.

BHM’s experts confer on a case-by-case basis and look over levels of service, levels of care, pharmacology, and other treatment options offering their insight.

BHM knows behavioral health is difficult and complex.

Combining behavioral health with medical adds extra nuances to case reviews.

Count on BHM’s experts to know the interrelationship of BH and medical care and navigate your team through the challenges of mandated integrations of care.