Substance Use Disorder (SUD)
Clinical need,approvals, and billingtelling one story.
SUD teams help clients from admission through every review, transition, and claim. Circle ensures that assessments, care, authorizations, and billing all line up across withdrawal management, residential, PHP, IOP, outpatient, and OTP care.
3x
Concurrent reviews cleared per UR day
As reported by Circle customers
An admission assessment by itself isn’t enough for the whole stay. Each review needs current proof of need and response, Circle helps teams collect this from the record.
Reimbursement structure
Payment logic varies by level of care and payer. Withdrawal management, residential, PHP, and IOP are typically authorized in blocks through concurrent review. Outpatient counseling is billed by service. Medicare pays enrolled opioid treatment programs (OTPs) through weekly bundles, which follow different logic than office-based care.
Relevant requirements and guidance
- ASAM Criteria and payer-specific criteria
- 42 CFR Part 2
- 42 CFR Part 8 (OTPs)
- The Joint Commission (TJC)
- CARF
- State licensing
We’re proud to be an Affiliate Member of the National Association of Addiction Treatment Providers. Supporting addiction treatment teams across the entire continuum of care. (opens in a new tab)
How it works in your daily routine.
Continued-stay review
From admission placement to today's need
Collect recent reassessments, treatment responses, medication changes, and discharge barriers for the next payer review. Utilization review can use the clinical reasoning already in the record, so you don’t have to rebuild the case from the intake note.
Concurrent review preparation
- Complete
Current reassessment
Updated since admission
- Complete
Treatment response
Pulled from this week's notes
- Review needed
Medication change
Prescriber rationale not found
- Review needed
Discharge barriers
Housing placement pending
Built into every review.
Prepare continued-stay reviews
Reviews use recent reassessments and treatment responses to show why today’s level of care is needed before the review window closes.
Resolve participation and note gaps
Approved services, participation, clinical notes, and billing are checked and compared before claims go out.
Apply the right program requirements
Each level of care, such as withdrawal management, residential, PHP, IOP, outpatient, and OTP, has its own clinical and payment rules. Circle keeps these rules organized and separate.
Documentation for the care delivered
Clinicians can see if a note needs more detail while it’s still open and sign off before anything is added to the EMR.
SUD privacy requirements
Circle is built to meet 42 CFR Part 2 requirements, including consent for treatment, payment, and operations, and provides extra protection for SUD counseling notes.
Focus feedback on recurring gaps
Every chart is checked against payer, CARF, TJC, and state criteria. This helps supervisors coach teams on recurring patterns.
What customers have measured.
3x
Concurrent reviews cleared per UR day
As reported by Circle customers
93%
Treatment plan timeliness as census grows
As reported by Circle customers
100%
Chart review coverage
Explore further
Know what each payer expects. Act before revenue is at risk.
See how Circle fits alongside the systems already in place.
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