Services

Revenue Cycle Services for Esketamine Clinics

Dedicated administrative support to manage patient prior authorizations, CPT coding, REMS observations, and insurance appeals.

Spravato Prior Authorization Management

Verification of medical necessity criteria and clinical documentation submission to secure insurance coverage for esketamine treatments.

Verification of patient insurance benefits and coverage policies
Pre-screening of clinical charts for documented antidepressant failures
Compilation and submission of prior authorization requests
Ongoing tracking of pending authorizations and renewal management

Learn more — Spravato Prior Authorization Management

Esketamine Claims Submission & Coding

Coding and billing services for Spravato drug administration and clinic observation time.

Application of CPT code J0013 for esketamine billing
Bundled billing configuration for Medicare using G2082 and G2083
Precise billing units calculations based on dosage (56mg vs 84mg)
Split claim management for drug delivery and office visit CPT codes

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REMS Documentation & Audit Protection

Compliance monitoring and documentation audits for the SPRAVATO REMS program.

Clinical chart audits for mandatory two-hour patient observation records
REMS registration verification for the clinic, pharmacy, and patient
Documentation template design for treatment sessions
Pre-audit reviews to identify billing vulnerabilities

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Denial Management & Appeals

Researching and filing appeals for denied esketamine claims.

Analysis of insurance denial explanation of benefits (EOB)
Preparation of custom appeal letters citing peer-reviewed clinical studies
Coordination of peer-to-peer review documentation for clinic physicians
Correction and resubmission of claims rejected due to coding errors

Learn more — Denial Management & Appeals