Built for SUD Treatment
Treat substance use, not the billing maze.
Coveragence keeps eligibility, authorizations, and payer rules aligned across the full SUD continuum — detox, residential, PHP, IOP, and outpatient — without your team chasing portals or fighting denials after the fact.
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THE SUD REALITY
Every level of care is a new payer puzzle.
Coverage, authorizations, and benefit caps shift at every step-down. Most RCM tools were never designed for it.
Continuum re-verification
Detox, residential, PHP, and IOP each trigger new auths, LOC reviews, and benefit checks — often with the same payer.
Self-pay coverage
A large share of SUD admissions arrive uninsured but qualify for Medicaid, Marketplace, or family commercial plans nobody surfaced at intake.
SCAs and LOAs
Out-of-network admits depend on Single Case Agreements that have to be tracked, dated, and re-negotiated rapidly.
ASAM medical necessity
ASAM criteria documentation has to align with each payer's interpretation — or claims get downgraded or denied.
Hidden benefit caps
Residential days and IOP visit limits are buried in plan documents and surprise programs mid-stay.
42 CFR Part 2
Confidentiality rules complicate eligibility checks and benefit coordination — especially with Medicaid MCOs.
HOW COVERAGENCE HELPS
An RCM stack designed for the way SUD actually gets paid.
Coveragence brings eligibility, payer rules, and authorization workflows into one platform tuned for addiction treatment.
Coverage discovery at intake
Identify Medicaid, Marketplace, COBRA, or commercial coverage for self-pay admissions automatically — before a clinical decision is locked in.
→ Eligibility Engine
Continuum-aware auth tracking
Track every authorization, concurrent review, and step-down across detox → residential → PHP → IOP in a single timeline.
→ Authorization Tracker
ASAM rules engine
Codify each payer's medical-necessity criteria, frequency limits, and documentation requirements so claims clear the first time.
→ Rules Engine
Daily coverage monitoring
Catch MCO assignments, Medicaid renewals, and plan terminations within hours — not after a 30-day denial cycle.
→ Coverage Monitor
The outcomes our SUD customers see.
71%
Reduction in SUD admission denials.
$2.4M
Annual revenue recovered through coverage discovery.
12 days
Faster days-to-cash on residential admissions.