How a Large SUD Facility Cut Denials by 36% and Reduced A/R Days by 47%

Faculty Profile

Location: USA

Specialty: Substance Use Disorder (SUD) Services

Size: Large multi-location facility

This case study shows how Plutus Health helped a fragmented SUD provider regain revenue control by fixing authorization workflows and cleaning up clinical documentation by applying AI-led automation.

The Challenges

• Authorization and Medical Necessity Denials
• Incorrect and Inconsistent use of CPT/HCPCS
• Documentation Shortfalls
• Payer Specific Challenges
• High Insurance AR

Plutus Health Plan Of Action

Plutus Health improves coding, authorizations, and medical necessity by addressing root causes, enforcing compliance, and reducing denials through real-time workflows and proactive reviews.

Issues Detected

• Decentralized Authorization Management – No dedicated UR team, leading to fragmented authorization tracking and inconsistencies.
• Lack of Dashboard Implementation – No centralized monitoring for pending, approved, or expiring authorizations, making real-time tracking difficult.
• Untrained Clinical Staff – No guidance on ASAM criteria or medical necessity language, resulting in incomplete or inaccurate documentation.
• No Structured Clinical Rounds – Irregular patient tracking and stay reviews, increasing the likelihood of missed updates and denied claims.
• Absence of Peer-to-Peer Review – No proactive discussions, leading to escalated denials and appeal complexities

After identifying the issues, we worked extensively to develop a personalized action plan that provides an end-to-end solution. To see the results download our case study