We help behavioral health and substance-use providers overturn denials and recover payment—with a fully managed service and no upfront cost. From residential stays to PHP and IOP, we handle the clinical evidence, appeals, payer submissions, payment follow-up, and responses to payer clawbacks. Your team stays focused on care.
“Continued residential treatment was not approved based on the information reviewed.”
Ongoing symptoms requiring staff support
Support needs relevant to transition planning
Completely free upfront. Start recovering denied revenue without an upfront investment.
One team manages recovery for your behavioral health program—from clinical documentation to payer follow-up and payment reconciliation.
From a team that has launched AI authorization workflows that have decisioned millions of authorizations. That experience now powers Reclaw’s approach to behavioral health denial recovery.
Start with privacy. Discuss HIPAA requirements, BAAs, and safeguards before sharing clinical records.
Our approach to privacy ↗A denied residential stay. A PHP extension that was not approved. An IOP claim that does not match the authorization. A payer requesting repayment after care has already been paid for. Reconsidering a behavioral health denial starts with a clear account of the patient’s needs, the treatment delivered, and why that level of care was appropriate.
Reclaw manages that work end to end. We bring the AI workflows and the team to run the process, from the first denial through payment reconciliation. Your clinicians provide clinical review where needed. We connect assessments, progress notes, nursing observations, treatment plans, and discharge planning to the payer’s stated reason—and handle the follow-through.
Fully managed at every step.
No upfront cost to get started.
Identify the treatment days under review, levels of care, and whether the issue concerns medical necessity, authorization, or claim details.
Bring assessments, progress notes, treatment plans, nursing observations, and authorization history together for the care under review.
Connect documented symptoms, staff interventions, progress, and readiness for a lower level of care to the requested level of care. Identify where additional context may help.
Build a traceable appeal draft for clinical review—or identify when a claim correction is the next step.
Submit the response your team has approved, track receipt and deadlines, and follow up on payer requests and decisions.
Follow the case through claim reprocessing, follow up on payment status, and reconcile the remittance so recovery is measured in dollars received.
“Continued residential treatment was not approved based on the information reviewed.”
First, verifyConfirm which records were included in the original submission.
Patient continues to require staff prompting to use coping strategies during periods of distress.
The record describes evening support needs relevant to planning a transition to a lower level of care.
From substance-use residential programs to mental health outpatient clinics, we manage the recovery work around the care you deliver.
Connect the patient’s documented needs, staff interventions, and discharge planning needs to the dates under review.
Clinicians review the supporting records and approve the appeal before submission.
Connect each point in the appeal to dated clinical records so the basis for reconsideration is clear.
Identify additional records and clarify open questions with your team while staying true to the documented care.
Ongoing support or an ad hoc review.
Choose what fits your team.
Connect your EHR for ongoing denial management, or drag and drop documents for ad hoc reviews. Reclaw brings the relevant records together to help you overturn denials and respond to payer clawbacks.
Behavioral health and substance-use records deserve careful handling. Discuss your organization’s privacy, security, and HIPAA requirements with Reclaw before sharing clinical information.
Review Business Associate Agreement (BAA) requirements, permitted data use, and safeguards as part of planning your clinical workflow.
This website collects business inquiries only. Please do not include patient names, clinical records, or other protected health information in a demo request.
Practical starting points for the teams
navigating denials and appeals.
Compare approved dates, units, and service details with the claim. A missing authorization number may need a correction; treatment days under review may need a clinical appeal.
Compare the original submission with the clinical record. Identify additional context that may support reconsideration, then connect each point in the appeal to its dated source.
Identify the denial reason before choosing the response. Track corrections and appeals through payer acknowledgment, the decision, claim reprocessing, and payment.
Have a workflow we should understand?
Yes. A clawback, or recoupment, is a payer request to recover a previous payment. Reclaw reviews the notice, original payment, and supporting records; identifies the applicable response process and deadlines; and prepares a response for your team’s approval. We manage payer follow-up and track any payment adjustments through resolution.
No. Reclaw is completely free upfront. We’ll explain the full commercial terms before you engage the service.
Reclaw handles the operational work from denial intake and evidence gathering to appeal preparation, approved payer submissions, follow-up, and payment reconciliation. Your team provides record access and clinical review where needed; Reclaw manages the process and keeps you informed.
No. A claim may need a correction, an authorization match, or clarification from the payer. Reclaw’s approach starts with understanding the denial so the team can choose the appropriate next step.
Reclaw takes the day-to-day denial recovery work off your team’s plate. Your clinicians retain clinical judgment and approve the response; we manage preparation, submission, payer follow-up, and payment reconciliation.
Reclaw identifies existing records that could add context and highlights questions for your clinical team. Appeals stay grounded in documented facts, with additional support included when available.
Integration availability will be scoped with your organization. We start by understanding where your denials, authorization history, and clinical records live rather than promising a connection we have not validated.
No. An approval or overturned denial still needs to be reconciled with claim processing and payment. Reclaw follows the case beyond the appeal decision, tracking reprocessing and reconciling payment with the affected claim. Payment depends on the payer’s decision and applicable coverage.
No. This is an informational website. Please do not submit patient names, records, or other protected health information. Any clinical data workflow will be established separately.
Get experienced support to help overturn behavioral health and substance-use denials.
We manage the recovery. You focus on treatment.