You’re not buying a dashboard. You’re hiring an authorization-defense team that brings software.
Higher-acuity behavioral health authorization workflows are too specific to fix with off-the-shelf SaaS, and too operationally heavy to fix with a consulting deck. Every Lucida engagement combines workflow diagnosis, custom build inside your existing stack, and a weekly UR-experienced advisor who operates alongside your team.
The three phases
Diagnose. Build. Operate alongside you.
Phase 1
Weeks 1–3
We diagnose
Before we build anything, we make sure we understand the actual workflow — not the one in the org chart, the one that runs at 2pm on a Tuesday.
- Workflow audit across admissions, UR, clinical, and billing. We interview the people doing the work, not just the people running them.
- Payer-mix analysis on your actual book of business — which payers drive volume, which drive denials, where the workflow effort and revenue leakage concentrate.
- Sample concurrent-review review on 10 recent cases, scored against the criteria each payer actually cites in their denials.
- Eligibility / PA gap analysis at admission across the same sample.
What you walk away with
A written assessment showing where authorized days are leaking, which payers and workflow steps drive the exposure, and the prioritized changes — workflow, documentation, integration — that would recover them.
Phase 2
Weeks 3–10
We build
The build phase is where the service becomes software. Every workflow we build runs inside the systems your team already uses — no new logins, no rip-and-replace, no clinician retraining.
- AI evidence-surfacing pipeline reads your EHR (Kipu, Valant, Alleva, Sunwave, TherapyNotes, SimplePractice) and surfaces medical-necessity evidence against ASAM / LOCUS / MCG.
- Per-payer workflow playbooks for the top 3–5 payers in your book. Aetna gets the Aetna workflow; Cigna gets Cigna's; your top Medicaid MCO gets its own.
- Eligibility and prior-auth detection wired into the admissions workflow — through APIs where they exist (Availity), through secure browser automation where they don't (most payer portals).
- Concurrent and continued-stay review packets auto-compiled and routed to the right UR nurse at the right time.
- Custom middleware where your stack has gaps (CRM ↔ billing, billing ↔ payer portal, ops tool ↔ EHR).
What you walk away with
A working authorization-defense layer running inside your stack — software you don't have to install, workflows your team doesn't have to learn from scratch.
Phase 3
Week 10 forward — ongoing
We operate alongside you
The system runs continuously. A dedicated UR-experienced advisor sits with your team on a weekly cadence to act on what the system surfaces — and to keep tuning as the payer mix shifts.
- Weekly working session with your UR, admissions, and finance leaders. Review the week's at-risk cases, prioritize concurrent-review prep, line up appeals and reconsiderations.
- Quarterly payer-mix re-analysis. Payers change PA requirements, criteria weighting, and submission rules on their own schedules — sometimes quietly. We catch and propagate changes.
- Continuous evidence-pipeline tuning against your real denial outcomes — what overturned, what didn't, what to weight more heavily next time.
- On-call appeal and reconsideration support when a denial lands in your inbox and the clock starts.
What you walk away with
A meaningful, sustained drop in authorized-day leakage — and a UR team that's spending its time defending authorizations, not assembling packets.
Who’s involved
Two teams. One authorization defense.
We work as an extension of your existing UR, admissions, and revenue-cycle operation — not on top of it, not next to it.
From your team
- Executive sponsor — usually the VP RCM, COO, or Executive Director who owns the cross-functional outcome.
- Director of UR — primary day-to-day partner; lives in the system's signal and the weekly working sessions.
- Director of Admissions — partner on the eligibility / PA pillar and the front-door workflow.
- Compliance Officer — co-owner of the medical-necessity narrative and clawback exposure.
- IT / EHR admin — read-only credentials, integration access, security review (usually a few hours total).
From Lucida
- Founder — owns the engagement strategy, the build sequencing, and the executive relationship.
- UR-experienced clinical advisor — runs the weekly working sessions, drafts appeal language, coaches clinicians on documentation.
- Engineering — builds the AI evidence pipeline, per-payer workflows, integrations, and payer-portal automation.
- Security & compliance — runs the BAA, scopes integration access, documents the data flows your team needs for audit.
Everything we produce is yours.
Whether you continue the engagement or not, the artifacts generated during diagnose and build are yours to keep and use with any other team or vendor.
- ·The written authorization-defense assessment.
- ·The payer-mix analysis on your actual book of business.
- ·Every per-payer workflow playbook we built.
- ·Every concurrent-review packet drafted during the engagement.
- ·Documentation of every integration, automation, and middleware path we built into your stack.
What an ongoing week looks like
Once the system is running.
Steady-state cadence after week 10. The rhythm shifts to continuous operation and weekly review.
Continuously
The AI evidence pipeline scores incoming charts, surfaces evidence and gaps, drafts narrative language for upcoming reviews, and routes work to the right UR nurse.
Daily
Admissions sees PA-requirement signals and eligibility status at intake. UR sees the day's at-risk continued-stay cases. Billing sees authorization-status changes.
Weekly
Working session with your UR, admissions, and finance leaders. Walk the week's at-risk cases, prioritize action, line up appeals and reconsiderations.
Quarterly
Payer-mix re-analysis. Update playbooks against any payer-rule changes detected during the quarter. Strategic review with executive sponsor.
Next step
Start with the Authorization Defense Assessment.
Free. Workflow audit across admissions, UR, and billing, payer-mix analysis on your actual book of business, and a sample concurrent-review review on 10 recent cases. Same diagnose phase, no commitment.