Who We Serve

RTC, detox, PHP and IOP billing, level by level.

Health Revenue Intelligence (HRI) serves behavioral-health organizations with complex revenue cycles, including RTC, detox, PHP, IOP, multi-level treatment providers, and organizations submitting institutional claims. The strongest fit is a program with steady claim volume, difficult authorization and utilization review, several payers, and denials, aged receivables or underpayments building up.

A patient's level of care begins with a clinical assessment and treatment recommendation. The payer then applies the member's benefits, medical-necessity criteria, authorization requirements and continued-stay review. That is where the revenue cycle holds or leaks.

Updated October 2026

RTC & Detox PHP & IOP Multi-level providers Institutional (UB-04)

Request a Billing Review → See how we work →

Deep specialty in

Detox: withdrawal management, from social detox to medically managed
RTC: 24-hour residential treatment
PHP: partial hospitalization
IOP: intensive outpatient
Institutional (UB-04) claims

We also take on outpatient, telebehavioral, community-based and specialty providers when the volume and payer complexity call for full-service billing.

Care and Billing

The revenue cycle for each day of care, from verification to payment.

Behind every claim is a patient mid-treatment and a clinician doing the work. Getting the billing right keeps care going. We work the codes and the authorization windows, and we look for underpayments.

One lapsed authorization can leave days unpaid.

Levels of Care

Billing detail, level by level.

Each level of care carries its own revenue codes, unit logic, authorization cadence, documentation demands, and denial patterns. The cards show how a level pays and where its claims break. Each level runs under HRI Managed, our billing engagement. A program opening a level of care for the first time starts with billing and credentialing for a new program. The PHP detail sits on its own page, PHP billing services.

RTC billing

24-hour residential treatment, billed per diem. The payer approves the days and reviews any request for more.

Revenue codes: Payer-specific. 1001 is residential treatment, psychiatric, and 1002 is residential treatment, chemical dependency; some payers use other codes
Units: Per diem, reported as a number of days; the payer's rules say which days count, such as leaving out the discharge day
Authorization: Prior authorization or an admission notice, then a continued-stay review for more days; the payer sets when
Documentation: Medical necessity for admission and continued stay; a documented face-to-face service each day billed; assessments updated on the payer's schedule
Where claims break: Stays past the authorized days, the discharge day billed as a day of care, days with no documented face-to-face service, assessments not updated on the payer's schedule
Underpayment risk: Days past what the payer has approved go unpaid; Ohio Medicaid pays only the first thirty days when a longer stay is not approved

UB-04Per diem

See UB-04 institutional billing →

What full-service RTC billing covers →

RTC and residential treatment billing →

Detox billing

Medically managed withdrawal, billed by the day. Each payer sets its own notice and review dates, some as early as two business days after admission and some after the seventh day.

Revenue codes: Payer-specific. Detox room and board is 0116, 0126, 0136, 0146 or 0156 by room type, and some payers use 1002 for residential detox
Units: Per diem, reported as a number of days; the payer's rules say which days count, such as leaving out the discharge day
Authorization: Preauthorization or an admission notice, then a continued-stay review; the payer sets when, and for some it is after the seventh day
Documentation: A physician's certification of medical necessity, and the documentation the payer's review looks for
Where claims break: Admission notice missed, stays past the payer's review day, claims billed at a different level or revenue code than the authorization, no physician certification of medical necessity
Underpayment risk: Days past the payer's review point need an authorization to be paid

UB-04Per diem

See UB-04 institutional billing →

Detox billing services →

PHP billing

Partial hospitalization. Per-diem or hourly billing gated by minimum daily-hour thresholds, with authorization and review rules set by each payer.

Revenue codes: Payer-specific. 0912 is partial hospitalization, less intensive, and 0913 is partial hospitalization, intensive; some payers want one of them on every date of service
Units: Per diem or hourly; minimum daily-hour thresholds
Authorization: Notice or prior authorization at admission, then a review for more days; the payer sets when
Documentation: Hours of service with beginning and ending times; progress notes tied to the treatment plan
Where claims break: Days short of the payer's minimum hours, a Medicare recertification not signed by day 18, notice or authorization missed at admission, units that do not match the payer's day
Underpayment risk: Some payers set the per diem by the day's service count or units, so a day counted low is paid low

UB-04Per diem / hourly

A closer look at PHP billing →

PHP billing guide →

IOP billing

Intensive outpatient. Usually paid by the program day. Errors in unit counts, minimum hours and same-day bundling reduce what is paid.

Revenue codes: Payer-specific; 0905 where the payer wants it
Units: Usually per program day; the payer sets the minimum hours
Authorization: Auth by approved dates or units; renewal cadence
Documentation: Session attendance, modality, progress
Where claims break: Lapsed authorization, short days billed as full days, same-day services billed beside the per diem, missing time records
Underpayment risk: Per diem rates below contract, bundling errors

UB-04 / 1500Per program day

A closer look at IOP billing →

IOP billing guide →

IOP billing services →

By state: Ohio · Iowa · Rhode Island · Utah

The cycle behind every level of care

Benefits verification (VOB)
Authorization and utilization review (UR)
Clean claims
Appeals and recovery
Care continues.

Institutional Claims

UB-04 behavioral-health billing for institutional claims.

Institutional claims, filed on the UB-04 form, depend on revenue-code accuracy, value, occurrence and condition codes, type-of-bill logic and date-span integrity. General medical workflows may miss the behavioral-health requirements in those areas.

/01

Type of bill

Facility and frequency logic set correctly so claims are neither rejected nor duplicated.

/02

Revenue + HCPCS pairing

Line-level integrity so each service maps to the code that pays it.

/03

Value / occurrence / condition codes

The behavioral-health-specific codes payers use to adjudicate, kept complete and consistent.

/04

Date-span & day-count

Reconciliation that keeps per-diem stays whole across concurrent reviews.

Scope & limitations

What we do, and what stays with your clinical team.

Health Revenue Intelligence does not make clinical placement or level-of-care decisions. Those determinations belong to your clinical team and treating providers. Our work is the revenue cycle behind the care your team delivers.

The revenue codes, unit logic, authorization cadence, documentation and denial patterns described on this page are drawn from published payer, Medicare and state Medicaid rules, and we can show you the source for each one. They are not instructions from your payer. We confirm the specifics for your organization before we act on them.

Level-of-care questions

What operators ask about billing by level of care.

We run detox through IOP under one roof. Can you bill all of it?

Yes, that whole ladder is squarely what we do: detox, RTC, PHP, IOP, multi-level treatment providers, and institutional (UB-04) claims. We also take on outpatient, telebehavioral, community-based and specialty programs when the volume and payer complexity call for full-service billing.

Is billing that different from one level of care to the next?

More than you'd think. Each level carries its own revenue codes, unit logic, authorization cadence, documentation demands, and denial patterns, and a claim can break on any one of those differences. RTC and detox bill per diem, PHP runs per diem or hourly with minimum daily-hour thresholds, and IOP is usually paid by the program day against the payer's minimum hours.

Where do denials usually hit at each level of care?

It differs by level of care, so here is where claims break at each one. Residential claims break on stays past the authorized days, the discharge day billed as a day of care, days with no documented face-to-face service, and assessments not updated on the payer's schedule. Detox claims break on a missed admission notice, a stay past the payer's review day, a claim billed at a different level or revenue code than the authorization, and no physician certification of medical necessity. PHP claims break on days short of the payer's minimum hours, a Medicare recertification not signed by day 18, a notice or authorization missed at admission, and units that do not match the payer's day. IOP claims break on a lapsed authorization, short days billed as full days, same-day services billed beside the per diem, and missing time records. Each item above comes from a payer's own published rule; the rule that applies to you is in your contract or manual.

Can you handle UB-04 institutional claims, or just professional billing?

We handle UB-04 work, and we treat it as its own competency. Institutional claims live or die on revenue-code accuracy, value, occurrence and condition codes, type-of-bill logic, and date-span integrity. Those are exactly the areas where general medical workflows may not capture behavioral-health-specific requirements.

Will you be involved in deciding what level of care a patient gets?

No. Clinical placement and level-of-care decisions belong to your clinical team and treating providers, full stop. Our work is the revenue cycle behind the care your team delivers, from benefits verification and authorization through clean claims, appeals, and recovery.

How do we know if our program is a good fit for HRI?

The strongest fit is a program with steady claim volume, tricky authorization and utilization review, several payers, and denials, aged receivables, or underpayments piling up. If that sounds familiar, send us the levels of care you bill and the payers giving you the most friction. We'll review the claim quality, denials, and underpayment exposure and show you where the revenue is leaking.

Billing across multiple levels of care?

We map each level.

We need two things from you: the levels of care you bill and the payers giving you the most friction. We review claim quality, denials and underpayment exposure, and show you where the revenue is leaking.

Request a Billing Review → See our appeals work →

A Business Associate Agreement is in place before any PHI is exchanged. For addiction-treatment programs, we also sign a 42 CFR Part 2 qualified service organization agreement before handling any records. Security & Compliance

Last updated: October 25, 2026