by Michael Arevalo, Psy.D., PMP on October 21, 2025
Behavioral health is uniquely complex, heavily scrutinized, and highly subject to federal funding rollbacks. Alone, each of these conditions would pose a threat to organizations’ revenue cycle management (RCM) capabilities.
But taken together — and combined with widespread staffing shortages and other challenges — they create an urgency that today’s behavioral health organizations can’t afford to ignore.
Manual or outdated behavioral health revenue cycle solutions risk exacerbating the problem by delaying reimbursement, generating noncompliance fees, and increasing insurance claim denials.
In a challenging and fast-changing landscape, the strength of a behavioral health organization’s RCM capabilities comes down to the strength of their tech stack. Comprehensive and integrated solutions can mean the difference between financial turmoil and a stable bottom line.
With that in mind, let’s look at seven technology must-haves every behavioral health organization should adopt.
1. Integrated EHR and Billing Systems
The most critical step in establishing effective financial management? Adopting an electronic health record (EHR) with integrated RCM capabilities.
Strong EHRs like Core Solutions’ Cx360 Enterprise platform have well-rounded features including:
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Unified clinical documentation, including templates for service lines such as ACT, mobile crisis, and therapy, which are particularly important in behavioral health, as payers require varying levels of supporting documentation to approve claims. These templates include language and codes for time-based care, as well as add-on rules.
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Insurance eligibility checks against bespoke and payer-specific lists. With the healthcare industry spending more than $1.3 billion managing preauthorization in 2023, these automated features can save organizations significant revenue.
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Seamless data flow, enabling behavioral health clinics to gain insights regarding billing statuses, claim denials, audit readiness, and more.
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Purpose-built RCM tools designed specifically for behavioral health care workflows and RCM needs.
The right EHR helps organizations gain greater control over their financial processes to avoid costly delays and claim rejections.
2. Claim-Scrubbing Tools
Claim denials are some of the biggest revenue-hindering culprits. One study found that a 1% increase in insurance claim denials translates to 2% of lost revenue for the average hospital.
Unfortunately, denials continue to rise as payers tighten requirements around eligibility, preauthorization, and submission accuracy. According to research published early this year, an 18% increase in denials occurred between 2020 and 2023 alone, with around 12% of all claims denied.
Claim-scrubbing tools review all insurance claims against coding standards to verify accuracy and completeness before claims are submitted. These technologies are particularly effective when integrated into an EHR system. The Cx360 platform, for example, uses an intelligent exception log to assess claim accuracy against numerous preloaded checks. You can scrub for:
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Frequency or duplication (e.g., same-day, same-provider)
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NCCI edits
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MUEs
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Invalid POS or telehealth modifiers
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Missing authorization units
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Timely filing
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Diagnosis-procedure incompatibilities
The platform’s RCM engine has helped clients achieve up to a 99% clean claim submission rate, thereby boosting their overall RCM efficacy and bottom-line performance.
3. AI-Powered Billing Capabilities
Artificial intelligence (AI) has quickly become one of the most essential behavioral health revenue cycle solutions. With AI solutions, teams can automate repetitive tasks and better ensure the accuracy of notes, clinical documentation, and other items that inform proper billing and coding.
The Cx360 platform, for example, offers AI-powered tools that:
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Flag higher-risk clients against integrated and customizable risk scores
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Streamline clinical documentation and ensure progress notes align with regulatory and payer requirements
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Analyze client and clinic data to spot trends that might be impacting EHR revenue cycle management
4. Compliance and Audit-Readiness Features
Payer rules and regulatory standards change frequently, particularly in today’s environment where Medicaid and other programs are affected by evolving healthcare priorities, policies, and regulations.
EHRs with embedded compliance trackers update when regulatory standards change, enabling behavioral health organizations to stay on track with the latest rules. Additionally, task management features notify specific team members of compliance-related deadlines, then filter tasks to the next appropriate team member upon completion. This ensures organizations to never miss a compliance deadline and adjust their workflows and billing procedures to meet any regulatory changes.
5. Performance and KPI Tracking
Analytics enhance an organization’s ability to pinpoint care delivery and RCM gaps that could be negatively impacting their revenue. Integrating the right data and key performance indicator (KPI) tracking with your behavioral health revenue cycle solutions could pay dividends.
According to the World Economic Forum, implementing a KPI strategy could save healthcare systems part of the $1.8 trillion they collectively spend on initiatives that don’t move the needle on client outcomes. It could also help them make better use of the data they have at their fingertips — 97% of which currently goes underutilized.
Top EHRs help teams monitor key metrics — like denial rates, collection trends, and days payments are held in accounts receivable (A/R) — to save time and money they might not even realize they’re losing. Intuitive data dashboards and visualizations make complex data actionable for any organization.
6. Interoperability
Behavioral health requires a uniquely high level of coordination with providers in other specialties, home health aides, occupational therapists, primary care physicians, and other medical professionals. As such, interoperable behavioral health revenue cycle solutions are especially critical, as they help ensure seamless collaboration across billing, clinical, and administrative teams not only within the behavioral health organization, but also across providers in the care continuum.
Teams can enhance their EHR revenue cycle management with interoperable data exchange standards such as the Fast Healthcare Interoperability Resources (FHIR) programming API. The Cx360 EHR, for example, is designed with an FHIR-enabled backend to allow for smooth, interoperable data exchange and effective collaboration.
7. Telehealth Billing Automation
The Center for Improving Value in Health Care reports that telehealth represented 47% of all mental health visits in 2020. In 2023, that number rose to 58%.
With demand for telehealth services increasing, it’s critical for organizations to adopt behavioral health revenue cycle solutions with automated telehealth billing capabilities. These EHR features can check the accuracy of remote care insurance claims, while empowering clients to actively participate in care and maintain their current billing and payment information in their client portal.
Driving Financial Stability With Smarter Behavioral Health EHR Software
Core Solutions’ Cx360 Enterprise platform offers robust data analytics, coordination capabilities, clinical documentation assistance, AI-powered solutions, integrated telehealth, and so much more. With these tools all in one central source, organizations can boost their EHR revenue cycle management and better secure long-term financial success in a challenging environment.
Schedule a demo today to learn how the Cx360 EHR and integrated AI tools can help automate and significantly improve your organization's RCM performance.
