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Outpatient Behavioral Health EHR for Therapy & Addiction Treatment
Trusted by behavioral health organizations nationwide:
What Challenges Do Outpatient Practices Face?
Excessive Documentation Burden
The Problem: Behavioral health clinicians spend significant time on documentation, often completing notes after hours instead of during scheduled work time. Administrative burden from charting, treatment planning, and compliance requirements is a leading contributor to clinician burnout and turnover.
Impact:
- Clinicians finishing notes outside scheduled hours
- Reduced patient capacity and longer waitlists
- High staff turnover disrupting continuity of care
- Experienced therapists leaving the field
Complex Compliance Requirements
The Problem: Behavioral health practices navigate overlapping requirements from state agencies, accreditation bodies, and payers. Missing a credential expiration, documentation deadline, or visit frequency requirement can trigger audit failures, claim recoupments, or lost contracts.
Impact:
- Staff hours spent manually tracking compliance deadlines
- Audit findings from missed documentation requirements
- Claims denied for non-credentialed providers
- Accreditation risks from inconsistent compliance
- Revenue loss from claim recoupments
Authorization & Payer Complexity
The Problem: Behavioral health practices manually track prior authorizations, session limits, and payer-specific requirements across multiple payers. Authorizations expire mid-treatment, session limits run out without warning, and each payer enforces different rules—mistakes mean denials.
Impact:
- Appointments scheduled after authorizations expire
- Sessions delivered beyond approved unit limits
- Claims denied for payer-specific documentation gaps
- Revenue lost when authorization renewals are missed
- Administrative time spent on manual authorization tracking
How Our Behavioral Health EHR Solves These Challenges
Reduce Documentation Burden
Challenge: Clinicians spend significant time on documentation, often completing notes after hours—driving burnout and turnover.
Our Solution:
- Customizable note templates
- Flexible note auto-populations
- Ambient AI drafts notes during sessions
- Voice-to-text for narrative sections
Simplify Compliance Management
Challenge: Requirements from state agencies, accreditation bodies, and payers create constant audit and revenue risk.
Our Solution:
- Credentialing tracker
- Documentation deadline monitoring
- Visit frequency compliance flags
- Block non-compliant provider billing
- Audit-ready reporting
Automate Authorization Tracking
Challenge: Manually tracking authorizations and payer-specific rules leads to expired auths, exhausted session limits, and denials.
Our Solution:
- Real-time authorization unit tracking
- Low-unit alerts before sessions run out
- Auto-attach authorizations to claims
- Block submission when auth is missing or expired
EHR Features Built for Behavioral Health Practices
Behavioral Health Therapy Documentation
Templates, AI assistance, and workflows designed for how therapists and counselors actually document
Template Library:
- Individual, couples, and family therapy notes
- Group therapy with multi-participant tracking
- Psychiatric evaluations and medication management
- Intake assessments and biopsychosocial evaluations
- Treatment plans with goal tracking
- Progress notes, safety plans, and discharge summaries
AI Assistance for Better, Faster Notes:
- AI ambient listening drafts notes during sessions
- AI captures clinical details therapists might forget to document
- Voice-to-text for narrative sections
- Smart phrases for common clinical language
- Side-by-side note comparisons to track patient progress
- Auto-population from appointments, demographics, and chart
- Pull content from previous notes
Group Therapy Workflow:
- Mark attendance in a few clicks
- Write session content once (topic, interventions, activities)
- Add brief individual observations per participant
- System generates complete individual notes automatically
- Correct group therapy billing codes applied automatically
Key Benefits:
- Improve note quality while cutting documentation time
- Capture clinical detail therapists often forget to document
- Finish notes during sessions—not after hours
- Lower burnout by eliminating after-hours charting
Psychiatric & e-Prescribing Tools
EPCS-enabled prescribing with PDMP integration built for psychiatrists and psychiatric nurse practitioners
e-Prescribing with EPCS:
- Electronic prescribing via SureScripts to 95%+ of pharmacies
- EPCS with two-factor authentication through ID.me
- Schedule II-V controlled substance prescribing (stimulants, benzodiazepines, buprenorphine)
- eRefill, eRenew, and eCancel request management
- Print or fax when e-prescribe isn’t available
Safety & Compliance:
- Real-time NARX PDMP scores before prescribing
- Drug-drug and drug-allergy interaction alerts via Medispan
- Formulary verification for insurance coverage
- Complete audit trails for DEA compliance
- State prescription drug monitoring program integration
Medication Management:
- Prescribe controlled substances electronically and compliantly
- Reduce adverse drug events with interaction checking
- Streamline refill and renewal workflows
- Maintain complete prescribing audit trails
Key Benefits:
- Prescribe controlled substances electronically and compliantly
- Reduce adverse drug events with interaction checking
- Streamline refill and renewal workflows
- Maintain complete prescribing audit trails
Treatment Planning & Golden Thread
Connect diagnosis to goals to interventions to outcomes—structured for audit-ready documentation
Treatment Plan Creation:
- Customizable templates by program type
- Master lists of goals, objectives, and interventions
- Link diagnoses directly to treatment goals
- Set measurable outcomes for each objective
Golden Thread Documentation:
- Access treatment plans directly from progress notes
- Mandatory fields ensure required elements are documented
- Complete audit trail from assessment through discharge
Compliance Tracking:
- Automated reminders for treatment plan reviews and updates
- Track review due dates across all clients
- Build custom reports to verify audit readiness
Key Benefits:
- Pass audits with connected, complete documentation
- Demonstrate medical necessity throughout the care episode
- Reduce treatment plan creation time
- Prevent compliance gaps with mandatory fields and reminders
Billing Automation & Authorization Management
Capture charges automatically, track authorizations in real-time, and prevent denied claims before they happen
Automated Billing:
- Capture and bill charges directly from clinical documentation
- Individual and group therapy billing with correct CPT codes
- Missed and cancelled appointment billing
- Telehealth modifiers applied automatically
- Auto-attach authorizations to claims before submission
Authorization Tracking:
- Monitor pre-authorization units in real-time
- Low-unit alerts before sessions run out
- Track authorizations across multiple payers and plans
- Block claim submission when authorization is missing
- Maximize appointments before units expire
Eligibility & Revenue Protection:
- Automated eligibility checks before appointments
- Identify coverage changes and additional payers
- Charges capture only from signed notes
- Missing diagnosis codes are flagged for review
- Block billing for non-credentialed providers
- Service-specific eligibility checks for mental health benefits
Key Benefits:
- Reduce claim denials from authorization and eligibility issues
- Stop revenue leakage from expired or missing auths
- Spend less time on manual charge entry
- Catch coverage problems before service is delivered
Substance Use Treatment Management
Comprehensive tracking for IOP, PHP, and residential addiction treatment programs
Attendance & Engagement Tracking:
- Electronic attendance tracking across all program components
- Automated alerts for missed sessions based on program thresholds
- Attendance pattern analysis to identify at-risk patients
- Compliance tracking for IOP and PHP visit requirements
Drug Screening Management:
- Track urine drug screen collection dates and results
- Configure testing frequency by program or funding source
- Alerts when screenings are overdue
- Document dilute specimens, refusals, or other issues
- Visual timeline of screening history showing patterns
Medication Management for MAT:
- PDMP integration for prescription monitoring when prescribing buprenorphine or naltrexone
- Track MAT medications in patient record
- Document medication compliance
Regulatory Compliance:
- ASAM level of care criteria documentation
- State-specific substance use treatment requirements
- Build custom reports for accreditation and audits
Key Benefits:
- Identify at-risk patients through attendance patterns
- Track UDS compliance and alert when overdue
- Prescribe MAT medications with PDMP checking
- Document to ASAM and state compliance standards
- Reduce administrative burden on clinical staff
Outcome Measures & Assessments
Evidence-based screening tools with automatic scoring, trend tracking, and patient portal administration
Pre-Built Assessments:
- PHQ-9 (depression) and GAD-7 (anxiety)
- Columbia Suicide Severity Rating Scale (C-SSRS)
- PCL-5 (PTSD screening)
- AUDIT and DAST (substance use)
- CAGE-AID and ACE questionnaire
- Request custom assessments built within 24 hours
Automatic Scoring & Tracking:
- Instant score calculation—no manual math
- Track results longitudinally across visits
- Flowsheets visualize trends over time
- Identify patients not improving early
- Compare scores to baseline and previous measures
Patient Portal Administration:
- Send assessments to patients before appointments
- Patients complete on phone or computer
- Results flow directly into the chart
- Reduce in-session paperwork time
- Increase completion rates
Key Benefits:
- Demonstrate treatment effectiveness to payers
- Make data-driven treatment decisions
- Identify at-risk patients through score changes
- Build custom reports to demonstrate outcomes
Trusted by Behavioral Health Practices
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