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Circle Health

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Circle is the payer relationship system for behavioral health and healthcare organizations where reimbursement scrutiny never stops. It shows what each payer expects, where every chart stands, and what to do next before reimbursement is at risk. Circle works alongside your EMR and reads the systems you already use. Your EMR keeps the clinical record, and your RCM system handles claims. Circle tracks payer criteria, authorizations, documentation standards, and billing rules. What Circle does • Documentation: drafts notes, assessments, and treatment plans in your chart formats and checks them against payer, state, and accreditation criteria before the clinician signs. • Utilization management: prepares prior authorization packets, concurrent review talking points, and appeal letters from the chart, checked against InterQual, MCG, ASAM, LOCUS, or plan policy. • Compliance and QA: reviews every active chart while the client is still in care and sends each finding to the person who can fix it. • Pre-bill and record reviews: matches billed services to documentation before claims go out and builds cited evidence for records requests, denials, and recoupments. • Credential hygiene: checks state licenses, NPI, board actions, and OIG exclusions on a schedule, with a dated copy of each source.

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