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