From connected care
to a verified route.

Keep five evidence layers separate

A route can move only when the applicable policy, provider, coverage, service, and claim-field evidence all pass. These layers answer different questions. An NPI result does not prove payer enrollment. An eligibility response does not prove that a provider may bill the service. A completed client activity does not create practitioner time.

1. Policy: payer, product, code, credential, jurisdiction, place of service, and effective dates.
2. Provider: identity, credential, taxonomy, enrollment, PTAN, TIN, reassignment, location, exclusions, and transaction enrollment.
3. Coverage: payer, product, rank, eligibility status, effective dates, QMB status, and record provenance.
4. Service: clinician-reviewed diagnosis, consent, monitoring, care plan, coordination, distinct time, date, and clinical lock.
5. Claim: billing and rendering identifiers, diagnosis pointers, place of service, dates, version, approval, and acknowledgements.

Start with practice and privacy gates

Before importing client information, the practice records its BAA evidence, Part 2 determination, required access control, and remittance approach. Records from a Part 2 program are excluded during the controlled beta. If provenance is unknown, the workflow blocks import and route evaluation instead of guessing from a diagnosis.

Each treating provider then receives a separate readiness record. The selected credential controls which reusable rules can be considered. A clinical social worker, mental health counselor, or marriage and family therapist is not silently evaluated under a clinical-psychologist rule.

Use client completion as supporting evidence

Habit of Care can retain assignment and completion evidence for journaling, cognitive restructuring, discussions, visualizations, narratives, quotes, progress tracking, memories, EMDR activities, assessments, issues, goals, addiction recovery, breathing, and habit building.

The treating clinician decides what a result means. Ordinary completion remains supporting evidence only: it contributes zero qualifying practitioner minutes by default and does not qualify an ordinary portal activity as an RTM or DMHT device.

Read route maturity before reading the result

National access includes signup, protected setup, provider evidence, supported client intake, and route preview. It does not mean every payer and profession has an executable claim route.

• Controlled beta: a narrow, published rule may create a claim only within its exact scope and after every provider and release gate passes.
• Route candidate: the opportunity is visible, but manual review is required and claim submission is blocked.
• Unsupported or suspended: no direct claim can move.

The first executable rule is the published Original Medicare FFS G0323 controlled-beta route for a clinical psychologist in its stated Novitas JH, office, and 2026 scope. The 99484 pack remains a candidate. RTM and DMHT remain visible manual opportunities.

Preserve each claim and acknowledgement state

A claim version is created from a saved route decision and immutable evidence snapshot. Human approval remains required for the controlled beta. API receipt, TA1, 999, 277CA, 276/277, and 835 records remain separate so a transport response cannot be mistaken for adjudication.

Corrected and void versions link to the original version and rejection evidence. Habit of Care does not make payer calls, write human appeals, negotiate claims, or provide full-service billing representation. Secondary claims and automatic Medicare client collection are outside the first release.

Know exactly when platform pricing starts

There is no setup fee and no platform charge until the practice records its first positive payable claim. A positive allowed amount or confirmed payment through an accepted remittance source activates normal pricing immediately.

After activation, the monthly price is the greater of $49 or $10 per payable insured care month + $4 per successful permitted self-pay month + $2 per practice-funded month. Team accounts are unlimited, and Habit of Care does not take a percentage of collections. A denied controlled-beta claim creates no insured usage fee.

Actual collection remains disabled until the required pricing review, security gates, and payment configuration are confirmed.

Treat projections as scenarios, not promises

The CMS 2026 nonfacility carrier-file amounts reviewed for G0323 range from $53.56 to $74.37, with an unweighted average of $59.33 across the reviewed nonfacility rows. At that illustrative average, 20 payable care months equal $1,186.60 in gross allowed amount.

This is not a coverage decision or payment promise, and gross allowed amount is not expected cash collection. Locality, qualifying-participant status, Medicare participation, the Medicare share, client cost sharing, sequestration, secondary processing, denials, adjustments, recoupments, and the exact date of service can change the result. Confirm the current CMS files and the actual claim record before using a projection for planning.