Authorization defense · Pre-launch · Design partners open
The authorization-defense layer for behavioral health.
Stop losing concurrent reviews you should have won at intake.
For PHP, IOP, residential, detox, and SUD programs. Built into your existing EHR, CRM, billing, and payer-portal stack — never on top of it.
Built with practicing UR clinicians, behavioral-health RCM leaders, and ex-payer medical reviewers.
Methodology · Sources
v1.0
- ASAM Criteria4th Ed.
- LOCUS / CALOCUSSub-scores
- MCG Behavioral Health27th Ed.
- CMS LCD L37633MAC-jurisdictional
- HHS-OIG OEI-09-19-003502023
- 42 CFR Part 2Consent
Cite-checked against the denial language each major payer's reviewers actually use.
Rubric PDF — coming Q3 2026
§The evidence behind authorization defense
Primary sources · HHS-OIG · CMS
of sampled inpatient psychiatric outlier claims failed Medicare medical-necessity or documentation requirements.
Medicaid MCOs deny prior authorization at more than 2× the Medicare Advantage rate.
of sampled New Jersey adult Medicaid PHP claims had documentation deficiencies.
typical clawback lookback window on already-paid PHP and IOP claims.
Authorization defense is the single most evidenced revenue-loss driver in behavioral health, across two decades of federal audits.
§The authorization lifecycle
As it runs today vs. as it should.
One root cause across two decades of audits — documentation that doesn't defend the level of care at the moment the payer asks. The same leak appears at concurrent review, at the peer-to-peer, at appeal, and again 18 months later at audit.
Stage
Today
With Lucida
Stage
At intake
01
Today
Admissions guesses whether prior auth is required for this payer and level of care.
With Lucida
Eligibility and PA detection runs automatically by payer and level of care, before services begin.
Stage
Day 3–7 review
02
Today
UR nurse assembles the concurrent-review packet by hand — 4+ hours per case.
With Lucida
Evidence pre-surfaced against the payer's actual cited criteria (ASAM / LOCUS / MCG).
Stage
Continued stay
03
Today
Notes read "patient continues to benefit." Reviewer cuts the day.
With Lucida
Documentation gaps flagged before submission — PHQ-9, GAD-7, ASAM scores, step-down rationale.
Stage
Denial → P2P
04
Today
Physician walks into the peer-to-peer cold, holding the original chart.
With Lucida
P2P packet auto-compiled with the payer's denial language pre-rebutted.
Stage
Appeal
05
Today
Most denials never get appealed. The ones that do start from scratch.
With Lucida
Win-probability-scored backlog, draft language ready, deadlines tracked.
Stage
18 months later
06
Today
Clawback letter arrives. Payments reclassified as overpayments. Patients long discharged.
With Lucida
Physician certifications, attendance, and staff licensure already audit-ready.
Same root cause, two moments in time. Most tools touch one column; Lucida is built end-to-end against the other.
ASAM · LOCUS · MCG · CMS LCD L37633
Built with leaders across PHP, IOP, residential, detox, and SUD
§Lucida by role
One platform. Four people who feel it differently.
“Your team stops assembling concurrent-review packets and starts defending them.”
- 01Chart-level evidence surfacing against the criteria the payer is actually citing
- 02Auto-compiled peer-to-peer prep when reviews get flagged
- 03Appeals backlog scored by win-probability — workflow, not heroics
Methodology · UR Director
How we score medical necessity using ASAM Dimensions 1–6.
Read the methodologyNo fabricated outcomes · Pre-launch
§What we replace
One layer your team owns — instead of three you rent.
01 · Status quo
Outsourced UR shops
- —$15K–$45K/month per FTE-equivalent
- —Can't cover every patient every cycle
- —Tribal knowledge in their heads, not yours
02 · Status quo
Generic RCM vendors
- —Work denials after they happen, never upstream of authorization
- —Don't touch payer-specific medical-necessity criteria
- —15–25% contingency fees on recovered revenue
03 · Status quo
Manual UR + Excel
- —4+ hours per concurrent-review packet
- —Knowledge dies when the UR nurse leaves
- —No audit trail when the clawback arrives
Lucida replaces all three with one layer your team owns.
No contingency fees · No tribal knowledge
§Built for detox programs
Not retrofitted from PHP and IOP.
Detox is its own animal. Short LOS. ASAM 3.7-WM / 3.2-WM criteria. Withdrawal-severity reviewer scorecards (CIWA-Ar, COWS). Aggressive day-cutting from payers. Discharge transitions into residential or PHP that have to be authorized before the patient can step down.
We built the detox workflows from the criteria payers actually cite — not by stretching the PHP playbook one level higher and hoping nobody notices.
- ASAM Criteria3.7-WM / 3.2-WM
- Avg LOS3–7 days
- Withdrawal scoringCIWA-Ar · COWS
- Step-downPre-authorized
ASAM 4th Ed. · CIWA-Ar v.1989 · COWS v.2003
Lucida · Version 1.0 · Draft
Medical Necessity
Defense Rubric
For PHP · IOP · Residential · Detox · SUD
§The Lucida Medical Necessity Defense Rubric
We published the criteria we score against.
ASAM Dimensions 1–6 mapped to LOCUS sub-scores. MCG Behavioral Health 27th Edition indicators. CMS LCD L37633 alignment. Cite- checked against the denial language each major payer's reviewers actually use.
Read it before you talk to us. A UR Director will spend four minutes with it and know whether we've done the work.
We publish the rubric in full because secrecy is what bad vendors lean on. If a payer reviewer can read it, our customers should too.
Features
Every layer of the authorization lifecycle, covered.
From eligibility and PA at admission, through payer-specific workflows and continued-stay review, into the integration layer that ties it all back into the systems you already use.
Chart-Level Evidence Surfacing
Reads progress notes, assessments, and treatment plans to surface the evidence that supports the level of care — before a review is submitted, not after a denial.
Pre-Submission Gap Detection
Flags missing PHQ-9/GAD-7/ASAM scores, templated language, absent step-down rationale, and below-threshold service-hour weeks — while there's still time to fix them.
Payer-Ready Narrative Drafting
Drafts the concurrent-review and continued-stay narrative in the language each payer expects, citing the criteria they cite. Your UR nurse edits — they don't start from scratch.
ASAM / LOCUS / MCG Criteria Library
Per-payer mapping of which criteria set applies, which sub-criteria they weight, and what evidence overturns their typical denial language.
Integrations
Works with the tools you already use.
We connect to your existing systems — no rip-and-replace, no workflow disruption. If you use it, we can integrate it.
EHR
Clearinghouse
Billing
Payer Portal
Don't see your system? We'll connect it.
“Lucida diagnosed our continued-stay workflow in two weeks. The custom Aetna and Cigna playbooks they built — and the AI that drafts the review packet — recovered authorized days we'd been silently losing.”
Design Partner
VP, Revenue Cycle, Florida residential & PHP network
Prove it against your own payer mix.
Diagnose + build on us.
We’re working with a small number of design-partner programs in PHP, IOP, residential, detox, and SUD to co-develop Lucida against real authorization workflows. It’s a working partnership, not a freemium tier — and it’s the fastest way for a skeptical VP RCM or COO to see authorized days protected before a single dollar changes hands.
Claim a design-partner slotNo card required · No auto-charge · Qualification on a 30-minute call
Diagnose + build — no cost
Workflow audit, payer-mix analysis, and the first wave of build (concurrent-review pipeline + 2 payer workflows) at no cost. No card on file. No auto-charge.
Weekly working sessions
Direct time with the founder and our UR-experienced advisor. We tune the workflows against your payers and your actual book of business.
Lifetime preferred pricing
Design partners lock in an early-adopter rate on the day they convert. If we raise prices later, yours don't move.
Keep every artifact
Even if you don't continue, every payer playbook, workflow audit, and concurrent-review packet we produced is yours to keep.
FAQ
The questions behavioral health operators actually ask.
Quick answers on continued-stay review, how Lucida works inside your existing stack, and what the design-partner engagement includes.
What's the #1 cause of authorization revenue loss in behavioral health?
How do concurrent and continued-stay reviews work in higher-acuity behavioral health?
Is Lucida software, a service, or both?
How does Lucida work with our existing stack?
Is Lucida HIPAA compliant?
What is the design-partner engagement?
Find out how many authorized days you're leaving on the table.
We'll run a free Authorization Defense Assessment — workflow audit across admissions, UR, and billing, payer-mix analysis on your actual book of business, and a sample concurrent-review review on recent cases. You'll see exactly where the revenue is leaking.