Buckeye Health Plan & Molina Healthcare Policy Changes — Ohio
Ohio Medicaid MCO Update: Buckeye’s new behavioral health UM policies are paused (Not Effective Jan 1) Important update for Ohio Medicaid managed care (MCO) behavioral health providers: Buckeye Health Plan has announced a temporary pause on implementing its new behavioral health utilization management policies OH.UM.04, OH.UM.06, OH.UM.07, and OH.UM.09. These Buckeye policy changes will NOT […]
How CEOs Use Credentialing Services to Uncover Hidden Opportunities in Payer Contracting Strategy
For behavioral health CEOs, payer contracting decisions are no longer just back-office concerns—they are boardroom-level strategic decisions. The mix of in-network and out-of-network contracts directly shapes revenue reliability, operational risk, and long-term growth. Yet many organizations overlook a key asset in this equation: credentialing. Credentialing is often viewed as a compliance necessity. But when approached […]
How to Build a Smooth Credentialing Workflow: Expert Best Practices for Leveraging Credentialing Services
Credentialing in behavioral health is not just a checklist—it’s an ongoing system that affects every aspect of a provider’s ability to generate revenue, remain compliant, and deliver care. For credentialing coordinators managing multiple payer panels, provider onboarding, and regulatory updates, it often feels like the process never stops. And when things go wrong, the impact […]
How Credentialing Services Reduce Risk When Expanding Into New Networks or Markets
Expanding into new payer networks or geographic markets can unlock significant revenue opportunities for behavioral health organizations. But with that opportunity comes risk—financial, operational, and regulatory. For CEOs and behavioral health executives weighing in-network vs. out-of-network strategies, the credentialing process is more than an administrative hurdle. It’s a make-or-break function that can either accelerate growth […]
How Billing Managers Can Use Utilization Review Services to Turn Chronic Denials Into Predictable Revenue
In behavioral health billing, denials are more than just annoying—they’re expensive. And while many billing managers are skilled at correcting coding issues or chasing down missing information, one category of denial continues to drain revenue with frustrating regularity: services denied for authorization or medical necessity reasons. These denials are often avoidable. But only if they’re […]
Why Clinical Directors Are Turning to Utilization Review Services to Stay Ahead of Payer Scrutiny in 2026
In 2026, clinical directors in behavioral health are facing a dramatically different compliance landscape than they were just a few years ago. Payer audits are more frequent. Documentation requirements are more rigid. Denials tied to insufficient medical necessity are climbing. Even well-structured programs are seeing treatment extensions questioned—and services flagged for retroactive review. In this […]
How Utilization Review Services Support Compliance for Small Behavioral Health Practices
For small behavioral health practices, staying compliant with payer requirements isn’t just a regulatory necessity—it’s a direct factor in whether you get paid, how quickly, and how consistently. Unfortunately, one of the most overlooked drivers of billing compliance and revenue risk is utilization review (UR). Many practice owners try to manage utilization review internally—assigning the […]
The Hidden Costs of Prior Authorization Delays: A Data-Driven Look at Mental Health Billing Inefficiencies
Delays in prior authorization don’t just impact patient care—they quietly chip away at your revenue, staff efficiency, and organizational growth. For Operations Managers in mental health settings, authorization lag is more than a scheduling problem. It’s a source of operational waste that few practices are equipped to track or resolve effectively. When authorizations are mismanaged, […]
How to Maintain Revenue Flow During a Mental Health Billing Software Transition
Switching billing platforms in a mental health practice is more than a technical update—it’s a business-critical decision that can directly impact your cash flow, patient experience, and compliance standing. Whether you’re switching vendors due to growth, functionality gaps, or billing performance issues, the transition phase can be high-risk without a revenue continuity plan. For practice […]
How to Manage Behavioral Health Revenue Cycle Management and Reduce Payment Delays
Behavioral health revenue cycle management (RCM) is often the hidden backbone of practice sustainability. When it runs well, billing and reimbursement feel seamless. But when it breaks down? Cash flow stalls. Staff burn out. And practice growth becomes a frustrating guessing game. If you’re a behavioral health provider—especially one running an ABA clinic, IOP, or […]
