CriteriaIQ R Reviews & Product Details

CriteriaIQ RCM is a behavioral health revenue cycle management platform built specifically for substance use disorder and psychiatric treatment centers. Designed by a clinician with 20 years of utilization review experience, CriteriaIQ RCM gives UR and billing teams the tools they need to stop losing revenue to authorization lapses, unmanaged denials, and missed concurrent review deadlines. Core Features: CriteriaIQ RCM provides real time authorization tracking with concurrent review deadline alerts, so your team never misses a window. Denial management with root cause analysis by payer gives you visibility into exactly why claims are being denied and which payers are the biggest problem. Peer to peer review scheduling keeps your clinical team organized and ready. Verification of benefits workflows streamline eligibility checks before admission. The client facing portal gives facilities a clean view of their authorization and revenue cycle status. Built in analytics and metrics dashboards surface trends across your entire book of authorizations so leadership can make data driven decisions. Clearinghouse integration and billing workflows connect your UR and billing operations in one place. Who It Is For: CriteriaIQ RCM is purpose built for behavioral health and SUD treatment centers using Kipu EMR, though it works alongside any EMR system. It is ideal for facilities with 20 to 200 beds that are losing revenue to authorization gaps and want a purpose built solution rather than a generic RCM platform that does not understand behavioral health workflows. Why CriteriaIQ RCM: Most RCM platforms were not built for behavioral health. They do not understand concurrent review cycles, ASAM level of care criteria, payer-specific behavioral health authorization requirements, or the peer to peer process. CriteriaIQ RCM was built from the inside out by someone who has lived in these workflows for two decades. The result is a platform that speaks the language of behavioral health UR from day one.