Solutions, Health, Behavioral health

Parity, level-of-care, safety

MHPAEA parity is not a checkbox. It is a documentary obligation that re-tests on every UM decision. Owl reads every progress note, every level-of-care assessment and utilization memo, walks ASAM, LOCUS and CALOCUS criteria, and writes a parity-defensible determination with a medical comparator.

2-yr contestability lookbackApp date → DOL
Outpatient, therapist2024-08-04
Initial intake: moderate MDD, GAD; weekly CBT initiated
Crisis line2025-02-12
Crisis call: passive SI without plan; safety plan updated
PHP discharge2025-04-22
PHP completed (3 wk), discharged to IOP at LOCUS 4
External, state PDMP2025-08-09
State PDMP shows new benzodiazepine fill from out-of-network ED, no entry in chart
IOP authorization2025-09-30
IOP step-down request denied for medical-necessity; current review
External, IRO corpus2025-10-04
IOP-step-down denials at this severity overturn at 64% on external review

NQTL parity

Med-surg comparator drafted

64%

Overturn risk if denied

$0

Avoidable cost of a wrongful denial

03A real claim, walked end to end

One IOP step-down: a parity-defensible determination in 1.7 seconds.

Anonymized composite. Member 32M, MDD + GAD, completing PHP and requesting IOP step-down. The carrier denied medical necessity; this is the post-denial reconstruction.

Auth #
BH-2025-44811
Service
IOP step-down, 9 hr/wk
Member
32M, F33.1, F41.1
LOC
PHP → IOP
Determination
Overturn: approve
OwlVision
What it read
PHP discharge summary
14 pp
Read, LOCUS 4 documented
Outpatient therapy notes (12mo)
168 pp
Read, indexed, cited
Crisis call + safety plan
8 pp
Read, risk timeline built
ASAM + LOCUS criteria
22 pp
Read, criteria walked
Plan medical policy BH-3.4
18 pp
Read, rule applied
Structured extraction
Member 32M; F33.1 (MDD recurrent, moderate) + F41.1 (GAD); LOCUS 4 at PHP discharge; 1 prior crisis event 2025-02; IOP step-down requested; ASAM Dim 5/6 supports continued structured care; plan policy BH-3.4 covers IOP at LOCUS ≥ 4.
OwlSignal
What the world said about the claimant

External data only. None of this lives in your CMS. Owl gathered it from public records, professional networks, registries and the open web, then resolved it to this claimant.

PAR-01
NQTL parity exposure on denial

Plan’s medical-surgical comparator (cardiac rehab Phase II) auto-approves at LOCUS-equivalent severity 87% of the time. Denying IOP at LOCUS 4 with documented step-down clinical basis creates an NQTL parity disparity exposure under MHPAEA, reportable to DOL and state DOI.

MHPAEA NQTL comparator dataPlan med-surg comparator: cardiac rehab Phase IIDOL MHPAEA enforcement guidance 2025
IRO-12
IRO overturn risk: 64% at this severity

Owl IRO corpus (n=180K) shows IOP step-down denials at LOCUS 4 with completed PHP overturn at 64%. Procedural denial language ("no medical necessity documented") triggers an additional procedural-defect bump on appeal.

Owl IRO corpus 2024–2025CMS Stars 2025 specState DOI external review filings
PDM-04
External fill detected via state PDMP

State Prescription Drug Monitoring Program shows a benzodiazepine fill from an out-of-network ED on 2025-08-09, not entered in the chart. Increases acuity argument for continued IOP-level structure; route to care manager.

State PDMPSurescripts cross-PBM historyED claim feed
CRT-07
ASAM + LOCUS criteria support IOP

ASAM Dimensions 5 (relapse / continued use potential) and 6 (recovery environment) both support continued structured care at the IOP level. LOCUS 4 criteria fully met.

ASAM Criteria 4th ed.LOCUS 2024 frameworkPlan med policy BH-3.4
OwlAssist
What it answered
Examiner asked
Is the IOP step-down medically necessary, and is the denial parity-defensible?
Owl answered in 1.7s

IOP is medically necessary, and the denial is not parity-defensible. Clinically, the member completed PHP at LOCUS 4 with continued mood instability, a recent passive-SI crisis, and a recent out-of-network benzodiazepine fill surfaced via PDMP. ASAM Dim 5/6 and LOCUS 4 both support continued structured care at IOP. The plan’s medical-surgical comparator (cardiac rehab Phase II) auto-approves at equivalent severity 87% of the time, creating MHPAEA NQTL disparity if BH IOP is denied. Recommend overturn and approve.

PHP discharge 2025-04-22PDMP record 2025-08-09ASAM 4th ed. Dim 5/6Med policy BH-3.4NQTL comparator memo
Examiner asked
Build the NQTL comparator memo we’d need if DOL asks.
Owl answered in 2.1s

NQTL comparator: medical-surgical analog is post-acute structured rehabilitation (cardiac Phase II / pulmonary). Plan policy auto-approves cardiac Phase II at NYHA Class III equivalent severity 87% without secondary review. The proposed BH IOP review process (chart re-review + manual UM) imposes a more stringent process than the comparator. Under MHPAEA NQTL "no more restrictive" standard, the BH process is non-compliant as designed. Memo drafted with side-by-side citations to plan policy and DOL guidance.

Plan medical policy CV-2.1Plan medical policy BH-3.4DOL MHPAEA enforcement 2025Comparator memo template
04OwlSignal external data

What the world says about your Behavioral health claimants, none of which lives in your CMS.

Internal claim data is half the picture: it tells you what the claimant told you. OwlSignal continuously gathers external data (public records, professional and corporate registries, court dockets, social and open web) and matches it back to the claimant. These are the families that move the needle on Behavioral health.

PARParity (MHPAEA) Comparators

Medical-surgical NQTL comparator data (what the plan does on cardiac rehab, pulmonary rehab, post-acute SNF and home health) to test BH determinations against MHPAEA "no more restrictive" standard.

Plan medical policy library (med-surg)DOL MHPAEA enforcement guidanceOwl NQTL comparator corpus
CRTCriteria Corpora

ASAM, LOCUS, CALOCUS, CMS, MCG and InterQual BH criteria: walked element-by-element on every level-of-care decision, with version cites attached.

ASAM CriteriaLOCUS, CALOCUSMCG / InterQual BHCMS coverage policy
PDMPDMP & Cross-PBM

State PDMP and cross-PBM pharmacy data: controlled-substance fills, opioid + benzodiazepine activity, MAT history. Often material to acuity arguments and to safety planning.

State PDMPs (49 states)Surescripts cross-PBMNCPDP networks
IROExternal Review Decisions

IRO decisions from state DOIs and CMS: what gets overturned on BH denials, by severity and by LOC. Owl’s corpus is 180K decisions across 14 states.

State DOI external reviewCMS external reviewOwl IRO corpus
PRVProvider Quality & Sanctions

OIG LEIE, state behavioral-health board sanctions, DEA action database, Owl’s cross-payer prescribing graph and BH provider outcomes graph.

OIG LEIE, SAM.govState BH licensing boardsDEA databaseOwl BH outcomes graph
POLPolicy & Plan Constructs

Plan EOC, BH medical policy library, medical-surgical comparator policies, NQTL design documentation. Read once, walked on every BH determination.

Plan EOC + BH med policyMed-surg comparator policiesNQTL design library
Refreshed daily, matched by identity-resolution, every observation cited to its source.
05What changes

Numbers from health plans running Owl on BH UM in production.

MetricWithout OwlWith Owl
Files read end-to-end29%100%
Time to LOC determination7.2 days6 hours
Auto-approval rate, clean cases8%52%
Overturn rate at IRO46%14%
NQTL comparator memos draftedmanualauto, per case
DOL MHPAEA findings, plan-level40
Source: rolling 12-month average across 4 health plans, UM + appeals, n = 84,200 BH determinations.

Built for the regulatory shape of Behavioral health.

MHPAEA, NQTLSide-by-side med-surg comparator drafted on every BH determination. DOL audit-ready.
HIPAA, 42 CFR Part 2SUD records protected under heightened consent + segregation. Part 2 controls baked in.
CMS, ACA §1557Member-readable adverse-determination notices. Section 1557 nondiscrimination covered.
NCQA, BH-7 / UM-2BH credentialing and UM decision turnaround tracked, accreditation-ready.
Reg AI / NYDFSBias testing, model documentation, human-in-the-loop on every adverse decision.
State DOI BH parityState-specific BH parity reporting (CA, NY, IL, TX, MA) generated automatically.
SOC 2 Type IIAnnual audit, continuous controls monitoring. Report under NDA.
Member safetyCrisis-event detection escalates to clinical staff in real time.
07Integrations

Lives where your Behavioral health files live.

Core admin

HealthEdge, Trizetto Facets, QNXT

UM platforms

GuidingCare, Aerial, ZeOmega Jiva, MedHOK

BH-specific

Headway, Brightside, Lyra, Spring Health, Carelon BH

EHR / records

Epic, Cerner, NextGen, Welligent, Streamline

Criteria libraries

ASAM, LOCUS, CALOCUS, MCG, InterQual

Identity & SSO

Okta, Azure AD, PingFederate, SAML, SCIM

08Get started

Bring us a quarter of BH denials. We’ll show you the parity exposure on day one.

Two-week pilot. Your BH stream, your tenant, your medical policy. We measure cycle time, IRO survival, NQTL comparator quality and DOL audit-readiness against your own ground truth.