Find billing issues before they become denials.
Paid service liveA focused report for behavioral-health revenue-cycle teams. You send a five-column, no-PHI CSV; we return cited findings that explain what was flagged, why it matters, and where the source came from. No claims submission, no PHI intake, no fake savings numbers.
Built for operators who need evidence.
- Per-finding citations and provenance.
- NPPES NPI verification and OIG LEIE screening.
- Monthly exclusion recheck option.
- Five-column no-PHI CSV intake.
A denial report without citations just creates another cleanup project.
Billing teams do not need another black-box score. They need a short list of findings that can be checked, assigned, and defended: which row was flagged, what source supports the concern, and what a human should review next.
A report your team can work from.
Cited findings report
Each finding includes the input row, what was flagged, why it matters, the cited source, and a recommended next step for human review.
No-PHI intake check
Before review starts, the CSV is checked for obvious PHI-shaped fields such as patient names, dates of birth, MRNs, member IDs, addresses, and free-text clinical notes.
Credentialing provenance
Provider NPI checks use NPPES and exclusion screening uses the OIG LEIE, with source, timestamp, and result recorded for the report.
Operator-ready summary
Findings are grouped by severity and action type so billing, credentialing, and compliance teams can decide what to fix first.
Cited finding anatomy
This is a synthetic example showing the report shape. It is not a real payer policy, reimbursement rule, or legal conclusion.
| Field | Synthetic example |
|---|---|
| Input row | SYN-014 |
| Finding | Provider NPI could not be verified against the expected public-source record. |
| Why it matters | Credentialing mismatch can create billing, enrollment, or audit follow-up work. |
| Citation | [source title] / [section] / [URL or file] / [reviewed date] |
| Recommended next step | Human reviewer confirms provider identity and updates the billing or credentialing record. |
Three steps from CSV to cited findings.
Send a five-column CSV
Use the agreed no-PHI structure only. Do not include patient names, member IDs, MRNs, dates of birth, addresses, notes, or full claim records.
We review and cite each finding
BHR runs deterministic checks, reviews flagged rows, and attaches source/provenance to each finding instead of returning a vague risk score.
You decide and document
You receive the cited report, recommended next steps, and review notes. Your team makes the final billing, credentialing, and compliance decisions.
Keep exclusion evidence current.
The report can become a monthly service: send the scoped provider roster, and BHR returns a recheck summary for NPPES and OIG LEIE with source provenance, timestamps, and changes since the prior month.
What the monthly file shows
- Provider NPI verification result.
- OIG LEIE screening result.
- Source and timestamp for each check.
- Rows that changed or need human review.
- 42 CFR 455.436 citation surfaced for the monthly exclusion-check cadence.
This is screening evidence and workflow support, not a legal determination.
Plain answers before we scope it.
Is this a software license or a service?
It is a paid service engagement built around the live RCM and credentialing work. We scope the CSV format, review the rows, and return a cited findings report.
Do you need PHI?
No. The intake is intentionally limited to five no-PHI columns. If a file contains PHI-shaped data, it should be corrected before review starts.
Do you submit claims, appeal denials, or guarantee payment?
No. The report flags and cites findings. It does not submit claims, appeal denials, post payments, or guarantee reimbursement.
Is this HIPAA-certified?
No. We do not claim HIPAA certification. The service is designed to avoid PHI intake; any real-data engagement would require the appropriate agreement and boundary first.
What is the monthly exclusion recheck?
For scoped provider rosters, BHR can recheck NPPES and OIG LEIE monthly and return a change report with source provenance. 42 CFR 455.436 is cited for the monthly exclusion-check cadence; final compliance decisions remain with your organization.
Do you publish ROI or denial-reduction numbers?
No. We do not publish savings, denial-rate, or recovery numbers until they are measured and defensible. The first report is about cited findings, not fabricated outcomes.
Start with the report, not a platform migration.
Send a short note about your billing review need, the approximate row count, and whether you want the monthly exclusion recheck included. Do not include PHI in the message.