Behavioral Health Payment Integrity
Your largest payment integrity gap is also your fastest-growing compliance risk.
Machinify recovers 15–20% of paid amounts — without restricting care, creating parity risk, or requiring internal behavioral health coding expertise.
THE MACHINIFY APPROACH
Built for the hardest category in payment integrity.
AI-powered claim triage
Machine learning models flag behavioral health claims anomalies like upcoding patterns, session-length outliers, telehealth modifier misuse, and impossible-day billing.
Certified behavioral health coders
Every flagged claim is reviewed by a certified coder with behavioral health expertise. Each determination is documented and defensible.
Pre-pay and post-pay coverage
Machinify supports both pre-payment and post-payment review environments. Pre-pay review is especially important for out-of-network behavioral health claims, where post-pay audit leverage may be limited.
Parity-ready documentation
The program documents audit processes, actions, and decisions for behavioral health in the same way it captures medical-surgical claims decisions.
Turn behavioral health from risk into recoverable value with Machinify
THE EVIDENCE
What the data is already showing.
Your questions answered.
Payer leaders evaluating behavioral health payment integrity programs often raise similar questions. Here’s how Machinify addresses each one.
Will this violate mental health parity laws?
No—failing to apply consistent review across behavioral and medical claims is the greater risk.
Machinify aligns audit methodology across both domains and produces the comparative documentation required to demonstrate parity compliance.
Does this restrict access to behavioral health care?
No. The program focuses strictly on coding accuracy and documentation—not clinical decision-making.
It does not involve prior authorization or medical necessity determinations.
What if past audits created provider friction?
Earlier approaches relied on broad, non-specialized review.
Machinify uses targeted claim selection, behavioral health expertise, and clear rationale—reducing unnecessary abrasion while addressing real issues.
How can low-dollar claims be reviewed economically?
Manual review doesn’t scale.
Machine learning triage identifies the claims most likely to warrant review, making even low-dollar claims viable at scale.
Isn’t federal parity enforcement paused?
Federal timelines may shift, but enforcement hasn’t stopped.
States like California, New York, and Pennsylvania continue active oversight, and private litigation remains ongoing.
Recover what you're missing. Meet what regulators expect. Protect the network you've built.
Machinify’s behavioral health payment integrity program is already deployed in one of the most stringent parity enforcement environments in the U.S. It’s ready for your plan today.
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