01
Payer criteria
PDFs, portals, plan rules, and tribal knowledge.
ThalamusBook walkthroughBehavioral-health operations platform
One case record for behavioral-health payer operations.
Thalamus keeps payer rules, clinical evidence, drafted work, and approvals attached to each case from intake through appeal.
39-43
PA requests / physician / week
12-13 hrs
staff time spent on PA weekly
89%
physicians report treatment abandonment from PA
The problem
Behavioral health runs on complex rules, tight clocks, and scattered evidence.
Generic RCM tooling was built around medical-surgical workflows. Behavioral-health teams carry payer-specific LOCUS, ASAM, InterQual BH, continued-stay reviews, portal work, faxes, and appeals at the same time.
02
Clinical evidence
EMR notes, diagnosis, LOC, treatment plans, and uploads.
03
Human judgment
Coordinators, UM nurses, clinicians, and RCM leads.
Platform
One case record.
Multiple workflows.
RCM, CDI, and Care are not separate evidence stores. They are workflow surfaces on the same case record, with the same audit trail.
Surface
Workflow
Owner
Status
01
Thalamus RCM
Prior authorization, concurrent review, and denial management carried across the same operational case record.
Workflow
Prior auth / Concurrent review / Denial management
Owner
RCM + UM
Status
Pilot
02
Thalamus CDI
Pre-sign documentation checks surface medical-necessity gaps while the clinical context is still fresh.
Workflow
LOCUS / ASAM / Queries
Owner
CDI + Clinicians
Status
Beta
03
Thalamus Care
Patient intake, check-ins, medication pickup, and follow-up tasks stay attached to the operational record.
Workflow
Intake / SMS / Follow-up
Owner
Care teams
Status
Coming soon
Product workflow
Prior auth and denials run agent-first. Every payer rule travels with the case.
Two RCM workflows from the deck, shown as one operational loop: queue, draft, human approval, and recovery.
Control point
Done by agents. Approved by your team. No autonomous payer submission.
Case-record diagram
Evidence, payer rules, drafts, and approvals move as one record.
The interface changes by workflow. The underlying case record stays the same, so teams do not reconstruct context at every handoff.
Inputs
Evidence
EMR notes
Treatment plan
Uploads
Payer portal
Rules
LOCUS
ASAM
Plan policy
Due dates
Source of truth
Case record
Live
Eligibility
Coverage, facility, level of care
Criteria
Payer policy matched to evidence
Drafts
Packets, queries, appeals, tasks
Audit
Reviewer, source, field history
Each workflow writes back to the same audit trail: who changed what, why it changed, and which source supported the decision.
Work surfaces
01
Queue
Prior auth and denial queues stay organized by payer clock, reason, and review owner.
02
Drafted by agent
Agents assemble intake packets and appeal letters from the original case record.
03
Approved by your team
Your team reviews, edits, approves, or escalates before anything leaves the workflow.
Thalamus RCM - Prior Auth
Prior auth, agent-first.
From eligibility check to submission. Every payer rule carried in one record.
01
Queue
Active payer cases ordered by deadline, status, and owner.
02
Draft
Agent prepares the intake packet from the case evidence.
03
Approve
Your team reviews the packet before payer submission.
Outcome
Solves: prior auth bottleneck on every BH admission.
Workflow map
Queue to agent draft to human approval
Queue
01Active payer cases ordered by deadline, status, and owner.
Draft
02Agent prepares the intake packet from the case evidence.
Approve
03Your team reviews the packet before payer submission.
01 / Active payer queueapp.thalamus.doctor
02 / Agent-drafted intakeapp.thalamus.doctor
Review rail
Queue01
Draft02
Approve03
Human control
Done by agents. Approved by your team.
Thalamus RCM - Denial Mgmt
Denials, worked back to approved.
Triage denials by payer and reason. Appeal letters drafted from the original case record.
01
Triage
Denials grouped by payer, reason, clock, and case context.
02
Appeal
Agent drafts the appeal from original evidence and policy.
03
Recover
Your team approves the path back to authorized care.
Outcome
Solves: continued-stay denials and appeal backlog.
Workflow map
Queue to agent draft to human approval
Triage
01Denials grouped by payer, reason, clock, and case context.
Appeal
02Agent drafts the appeal from original evidence and policy.
Recover
03Your team approves the path back to authorized care.
01 / Denial queueapp.thalamus.doctor
02 / Appeal draft + evidenceapp.thalamus.doctor
Review rail
Triage01
Appeal02
Recover03
Human control
Done by agents. Approved by your team.
Beyond RCM
CDI catches gaps before sign-off. Care routes patient tasks before they become risk.
The same case record powers pre-sign documentation review and patient-facing SMS workflows.
Thalamus CDI - Beta
Catch documentation gaps at the keystroke.
Inline EMR overlay for LOCUS, ASAM, time-documentation, payer-rule gaps, compliant query workflow, and field-level audit trail.
Thalamus Care - Coming soon
Patient-facing tasks, over SMS.
Intake, check-in, medication pickup, and follow-up routed to a named human if risk is detected.
Trust posture
Built for regulated hospital operations.
Automation stays controlled. Reviews are attributable. Every field-level change can be traced back to source evidence.
Live
HIPAA-ready
BAA available for production
In review
SOC 2 Type I
Under audit
By design
Human-in-the-loop
No autonomous payer submission
Live
Field-level audits
Every draft, edit, and approval retained
Partnership
We start at your hospital, onsite with your team.
We do not drop a SaaS login in your inbox. Pilot scope is co-designed with your RCM lead.
01
Pre-discovery
2-4 weeks
Remote workflow mapping, success metrics, and pilot scope.
02
Onsite immersion
~1 month
We work alongside your RCM and UM teams inside the real workflow.
03
Operational pilot
4-6 weeks
One workflow live, measured outcomes, and weekly review.
04
Expand
Ongoing
Add modules and workflows on the same evidence layer.
Next step
See how much of your hospital's workflow Thalamus can run.
Bring one real workflow. We'll map automation coverage, human review points, pilot timeline, BAA, and security review packet.