One platform. Every rule you answer to.
Your states, counties, payers, funding streams and programs, written down once and applied to every note before it's signed. Your QA team approves every rule. Live in weeks, not quarters.
Note rule sources
Lakeshore Behavioral Health
CL-12 Clinical Documentation Standards
Org policy
14 rulesCL-19 Suicide Risk Screening & Safety Planning
Org policy
9 rulesP2-01 42 CFR Part 2 Confidentiality & Consent
Org policy
7 rulesMichigan Medicaid Provider Manual — Behavioral Health & IDD Supports (Oct 2026)
State manual
31 rulesGreat Lakes Community Health Plan Provider Agreement, Exhibit C
Payer contract
11 rulesCARF Behavioral Health Standards Manual — Section 2.B–2.G
Accreditation
18 rules
4 rules changed in the October Michigan Medicaid manual. Reviewed and published by your QA lead before any note was checked against them.
Six numbers every product already knows
Programs, accreditations, payers, clinical models, rules and locations are loaded once into your note rules. Notes are written with them, note checks apply them and billing uses them. These are the sample organization's numbers in the live demo.
- Programs & levels of care
- 7
- Read by notes, letters & appeals
- Accreditations & state licenses
- 4
- Read by note checks, letters & appeals
- Payers & funding streams
- 8
- Read by note checks, billing
- Clinical models
- 10
- Read by notes, supervision
- Approved rules
- 37
- Read by note checks, follow-ups
- Locations in two states
- 4
- Read by EHR connection, outcomes
The same note, checked differently where it should be
A note in Holland, Michigan, under Part 2 and paid by a grant is not a note in Toledo billed to an Ohio MCO. Pick a combination to see the exact checks a note runs against before signing, and which layer each check comes from.
A Recovery Services — SUD & MAT note in Michigan, billed to Michigan Medicaid
55 checks before it can be signed
- 20
1 · Applies everywhere
Organization
- Treatment-plan goal or objective addressedOrg policy CL-12
- Named evidence-based interventionOrg policy CL-12
- 7
2 · State rules
Michigan
- Client response to intervention documentedOrg policy CL-12 §3.4; Michigan Medicaid Provider Manual §1.7
- Treatment plan current on date of serviceCCBHC Criteria 2023 §4.e (plan updated at least every 6 months); Michigan Medicaid Provider Manual §2.4 (IPOS)
- 15
3 · Service line
Recovery Services — SUD & MAT
- Required element: ASAM dimensions addressedRecovery Services — SUD & MAT template
- Required element: Toxicology results reviewed (when collected)Recovery Services — SUD & MAT template
- Required element: MAT adherence and diversion screenRecovery Services — SUD & MAT template
- Required element: Part 2 consent status confirmedRecovery Services — SUD & MAT template
- Default format: GIRPRecovery Services — SUD & MAT template
- Part 2 record: separate consent, redisclosure notice on every export42 CFR Part 2 (program flag)
- Write “positive toxicology result”, not “dirty urine”Recovery Services — SUD & MAT verbiage
- Write “return to use”, not “relapse failure”Recovery Services — SUD & MAT verbiage
- Psychotherapy code matches face-to-face timeCPT® 2026 Psychiatry guidelines; CMS Medicare Claims Processing Manual Ch. 12 §160
- Interactive complexity trigger documentedCPT® 90785 guidelines; CMS FAQ on interactive complexity (2013)
- Psychotherapy add-on time separate from E/MCPT® 90833/90836/90838 guidelines; CMS NCCI Policy Manual Ch. 11
- Initial plan signed within 30 daysGreat Lakes Community Health Plan Provider Agreement, Exhibit C §2; Northshore Mutual Health BH Policy 14
- Group notes individualized per memberMichigan Medicaid Provider Manual §1.7; CARF Standard 2.E
- Substance-use consent (Part 2) on file before disclosure42 CFR Part 2 §2.31 (2024 Final Rule); Org policy P2-01 §2
- Redisclosure notice attached42 CFR Part 2 §2.32
- 9
4 · Payer
Michigan Medicaid (state plan)
- Start and stop times on every progress note (Medicaid Provider Manual, Behavioral Health §1.7).Michigan Medicaid (state plan)
- Individual Plan of Service (IPOS) current on date of service; review at least every 12 months, sooner if needs change.Michigan Medicaid (state plan)
- Each note references the IPOS goal addressed and the client's response.Michigan Medicaid (state plan)
- Notes signed with credentials within 3 business days of service.Michigan Medicaid (state plan)
- Pre-licensed (LLPC/LLMSW) services require supervisor co-signature.Michigan Medicaid (state plan)
- H-codes billed in 15-minute units; 8-minute minimum per unit.Michigan Medicaid (state plan)
- Start and stop times documentedMichigan Medicaid Provider Manual, Behavioral Health & IDD Supports §1.7 (Documentation)
- Telehealth POS and modifierCMS Medicare Claims Processing Manual Ch. 12 §190; CY2026 PFS Final Rule
- Credential within payer scope for the codeMichigan Medicaid Provider Manual §17 (Peer Recovery Supports); MDHHS Medicaid Code Chart
- 4
5 · Funding stream
CCBHC demonstration
- Initial evaluation within 10 business days of first contactCCBHC Criteria 2023 §2.b.1
- Suicide risk assessment documented for the SRA measureCCBHC quality measure SRA
- PHQ-9 at intake and every 90 days, feeding DEP-REM-6CCBHC quality measure DEP-REM-6
- One qualifying visit per client per day for the PPS rateCCBHC PPS guidance
Programs and levels of care we configure
Each program and level of care gets its own note formats, required fields, codes and checks in your note rules. Here is what comes pre-loaded for each, before your policies refine it.
Programs · 15
- BIRP / DAP
- DLA-20
- H-codes
Note format per service code, treatment-plan goal linkage on every note, and the functional measure your state requires, at its cadence.
- 9 core services
- PPS daily visit
- Quality measures
Care-coordination and DCO documentation, the required-service checklist, and the data elements behind your quality-measure reporting.
- ASAM dimensions
- 42 CFR Part 2
- UDS
ASAM six-dimension assessments, Part 2 program flags and consent checks, toxicology results and dosing notes kept with the plan.
- ISP outcomes
- HCBS units
- Shift notes
Goal data against each ISP outcome, HCBS service definitions with 15-minute units, and plain-language shift notes for direct support staff.
- C-SSRS
- Safety plan
- Disposition
Risk screening fields, a safety plan built in the encounter, disposition and follow-up contacts, with response times captured from the call.
- FERPA
- Guardian consent
- School calendar
FERPA-aware disclosure rules, guardian consent checks for minors, and goals written so they can sit next to a student's school supports.
- Per diem
- Shift notes
- Continued stay
Daily and shift documentation that supports a per-diem claim, plus continued-stay reviews drafted from the week's notes.
- 42 CFR 482.61
- Restraint / seclusion
- Discharge plan
Daily progress notes against psychiatric-hospital record requirements, restraint and seclusion fields, and discharge planning from day one.
Assertive community treatment (ACT)
- Team contacts
- TMACT
- In-community
Team-based contact notes, where each contact happened, and contact frequency rolled up so fidelity reviews don't start from scratch.
Eating disorder
- Vitals and weight
- Meal support
- Level-of-care criteria
Vitals and weight trend fields, meal-support notes, and the criteria your program uses to step a client up or down a level of care.
Forensic and justice-involved
- Court reports
- ROI scope
- Supervision terms
Court and probation updates drafted from the chart, limited to what the client's release allows. Part 2 rules apply when SUD records are involved.
- CANS
- 90846 / 90847
- Multiple participants
Family sessions with several speakers, guardian consent and the CANS or your state's instrument, with family-therapy codes chosen by who was present.
- CoCM 99492–94
- Registry
- Warm handoff
Brief behavioral health notes for primary care, PHQ-9 tracking for a registry, and the time and roles collaborative-care billing depends on.
Human services
- Case management
- Housing / employment
- Grant reporting
Non-clinical service notes for case management, housing and employment supports, tagged to the funding stream that pays for them.
Peer support
- H0038
- Recovery goals
- Peer language
Notes written in peer language, not clinical interpretation, tied to the person's own recovery goals and billed in peer-service units.
Levels of care · 9
Outpatient
- 90832 / 34 / 37
- Add-ons
Psychotherapy time bands checked against documented start and stop times, with interactive-complexity and crisis add-ons where the note supports them.
Intensive outpatient (IOP)
- ASAM 2.1
- Weekly hours
Hours tallied across group and individual services each week against your program's minimum, with prior-auth dates tracked.
Partial hospitalization (PHP)
- ASAM 2.5
- Daily programming
Daily structured-programming notes, physician involvement and the attendance pattern your payer reviews for medical necessity.
Residential
- ASAM 3.x
- Per diem
Shift and daily notes that support a per-diem day, and continued-stay reviews on the schedule each payer sets.
Inpatient
- Daily progress
- Discharge
Daily physician and treatment-team notes, restraint and seclusion documentation, and a discharge plan that carries into outpatient care.
In-home and community
- POS 12 / 99
- Mobile capture
Place of service and location captured on the visit. Recording keeps going without signal and the draft arrives once you reconnect.
Telehealth
- POS 02 / 10
- Modifiers 95 / 93
Place of service, audio-only versus video, client location and telehealth consent, with modifiers set by each payer's rules.
Group programming
- 90853
- Group caps
One group note with an individualized section for each member, plus group-size limits and per-member billing.
Crisis stabilization
- 23-hour observation
- Disposition
Time-stamped observation notes, reassessment intervals, and a disposition with the follow-up contact it requires.
These are starting points. Thresholds, units and required fields come from your state manual, your payer contracts and your own policies, and your QA lead approves each one before it's enforced.
Owned by you. Auditable by anyone you choose.
Rules live at four levels, each with a named owner. A program can be stricter than the organization, and a field can be stricter than its template. Nothing is enforced until someone on your team approves it.
- 1
Globalowned by Clinical leadership
Every note names the treatment-plan goal it addresses.
Org policy CL-12 §3.2
- 2
Programowned by Program director
Recovery Services notes confirm Part 2 consent status and address ASAM dimensions.
Recovery Services — SUD & MAT
- 3
Templateowned by QA lead
Crisis encounters need exact start and end times, C-SSRS and a disposition.
Crisis encounter note
- 4
Fieldowned by QA lead
“Positive toxicology result”, never “dirty urine”, in the Toxicology field.
GIRP › Response › Toxicology
Audit trail
Governance eventsJenna Kowalski · approved denial fix
Corrected claim with rendering NPI queued (frequency code 7).
Oct 27, 11:02 AM
Dr. Maya Okafor · updated rule
Signature window confirmed at 72 hours for all programs (was 5 days for IDD).
Oct 25, 9:00 AM
Margent · detected cloned note
Note 100% similar to ses-2013 for the same client; transcript shows new content.
Oct 23, 8:52 AM
Dr. Maya Okafor · approved extracted rules
Reviewed and published 31 extracted rules to Note rules.
Oct 22, 1:41 PM
Dr. Maya Okafor · uploaded policy
Michigan Medicaid Provider Manual (Oct 2026) uploaded — 31 rules extracted, 4 changed.
Oct 22, 1:30 PM
Dr. Maya Okafor · exported audit packet
Retrospective audit of 120 IOP notes exported (signed PDF + CSV) for MCO review.
Oct 2, 4:30 PM
Every AI action records its inputs, the rules it applied, the model that produced it and the person who approved it. Nothing is ever submitted automatically. The clinician signs.
Straight answers for whoever signs off
Organizational AI you control, with defensible documentation and fewer surprises at audit time.
- What changes in the first quarter?
- Every note is checked before it's signed, not sampled months later. You see open findings by program each week and watch them fall.
- Who owns the rules?
- You do. Your note rules are built from your own policies and contracts, and your QA lead approves each rule. We can't change your rules, and neither can a model update.
- Will clinicians actually use it?
- The pilot measures it: edit rate, time to sign and active users by program. If adoption stalls, your success manager sees it before you do.
- How do we justify the spend?
- Time back per clinician, findings prevented, denials avoided. Reported monthly by program, in a format your board can read.
Open findings, last 12 weeks
Critical findings 18 → 3 while notes checked rose to 752/week
First signed notes by week four
A typical rollout for a multi-program agency. The pilot is one program with a small group of champions, and every later wave builds on what it teaches us.
- Week 0
Week 0: Kickoff and scope
Margent
We name your executive sponsor and implementation lead, send our controls overview and draft BAA, and fill in your vendor questionnaire with what is built and what is planned.
Your team
Pick the pilot program and 5–10 clinician champions. Name a QA lead and an EHR admin.
- Week 1
Week 1: Note rules from your documents
Margent
We load your policies, payer contracts and state manuals and propose rules, each linked to the page it came from.
Your team
Your QA lead approves, edits or rejects each rule. Most teams finish in two or three sittings.
- Week 2
Week 2: Your EHR, on a test account
Margent
We map the browser extension to your three highest-volume note types on a test account and check every field reads back. Copy and export work from day one.
Your team
Your EHR admin spends about four hours with our integration engineer.
- Week 3
Week 3: Champions tune the templates
Margent
A licensed documentation specialist runs side-by-side sessions, so drafts match your house style before anyone relies on them.
Your team
Champions run scripted role-play sessions in the sandbox and flag anything that reads wrong.
- Week 4First notes signed with real client data
Week 4: Pilot goes live
Margent
With the BAA executed, notes and note checks go live for the pilot program. Daily office hours for two weeks.
Your team
Champions document real care, and you see edit rate, time to sign and findings every day.
- Weeks 5–6
Weeks 5–6: Read the pilot together
Margent
We bring the numbers: time saved, findings caught before signing and rules that fired too often. Then we tune.
Your team
Leadership decides the rollout order. Supervisors and QA staff train on their queues.
- Weeks 7–10Every program live
Weeks 7–10: Program-by-program rollout
Margent
Each program goes live in its own wave with its own overrides. Billing checks, letters & appeals and follow-ups switch on as you're ready.
Your team
Program directors sign off before each wave, and nobody goes live without training.
- Ongoing
Ongoing: Stays current
Margent
When a state manual or payer contract changes, we propose the rule updates. Monthly reviews, quarterly business reviews.
Your team
QA approves changes before they apply, just as in week 1.
People you'll know by name
One team stays with you from kickoff to steady state, with no handoff to a support queue after go-live.
From Margent, named on day one
Executive sponsor
A member of our leadership team who meets yours monthly and can unblock anything.
Implementation lead
Owns the plan, runs the weekly check-in and keeps the timeline honest.
Clinical documentation specialist
A licensed clinician who tunes templates and note rules with your QA lead.
Integration engineer
Maps your EHR fields for the extension and checks every field reads back.
Customer success manager
Adoption reports by program and clinician, quarterly reviews and renewal without surprises.
What we ask of you
Executive sponsor
1 hr / month
QA or compliance lead
3–4 hrs / week, weeks 1–4
Clinician champions (5–10)
Normal caseload, plus feedback
EHR administrator
~4 hrs in week 2
No dedicated project manager or IT build on your side. The sandbox is free and stays yours through the pilot.
When the note is the exemption
From January 2027, expansion adults must show 80 hours a month of work or other activity, or qualify for an exemption. Many of the people you serve will qualify through a substance use disorder or a disabling mental disorder, and the state will check the record.
- Jul 4, 2025
H.R. 1 signed (Public Law 119-21). Section 71119 adds community engagement requirements for expansion adults aged 19–64: 80 hours a month of work, community service, a work program or half-time education.
- Jun 1, 2026
CMS issues the interim final rule (CMS-2454-IFC). A diagnosis alone isn't enough for the medically frail exemption: the condition must significantly impair the person's ability to meet the requirement.
- Jan 1, 2027
States must be enforcing the requirement. The statute sets the deadline as December 31, 2026, and states may start earlier. Expansion adults are also redetermined every six months instead of every twelve.
- Through 2028
States making a good-faith effort can get an extension to December 31, 2028. Self-attestation of frailty is allowed only through January 2028; after that, renewals need provider certification or medical records.
Exemptions that run through your chart
- Medically frail, which includes a substance use disorder, a disabling mental disorder such as serious mental illness, and an intellectual or developmental disability that limits daily activities
- People taking part in a substance use disorder treatment and rehabilitation program
- Parents and caretakers of a child 13 or younger, or of a person with a disability
- People already meeting, or exempt from, SNAP or TANF work requirements
What a note needs to support an exemption
- A current diagnosis tied to the active treatment plan, not a rule-out carried forward from intake
- Functional impact in plain words: work, self-care, housing, keeping a schedule
- A standardized measure at a steady cadence (PHQ-9, DLA-20 or your state's instrument)
- For SUD programs: level of care, attendance and engagement
- Why care continues, including barriers, not just “continue weekly therapy”
Your QA team can turn these into note checks, so a note missing function or a current measure is flagged before it's signed. Billing re-checks coverage on the shorter redetermination cycle. The clinician still decides what the note says.
Not legal advice. State rules are still arriving; check your Medicaid agency's guidance. Last reviewed October 2026.
Six shifts your documentation has to survive
What we're tracking for multi-program agencies in 2026, each with a source and what it means for the notes your clinicians write.
- 01
AI governance is becoming an expectation
The Joint Commission and the Coalition for Health AI published joint guidance in September 2025 covering governance, transparency, monitoring and bias assessment for AI tools. It's voluntary for now, and a certification is planned.
For your documentation: Expect auditors and boards to ask who approved each AI rule and how output is checked.
- 02
Program integrity is moving before payment
In late 2025, Minnesota began contractor-run prepayment review of 14 Medicaid services it named high-risk, including ACT, adult rehabilitative mental health services and recovery peer support. Claims can be held while documentation is checked.
For your documentation: A note has to stand up before the claim is paid, not just in a sample months later.
- 03
The CCBHC model keeps spreading
In May 2026, ten more states were selected for the CCBHC Medicaid demonstration, with start dates between July 2026 and July 2027. SAMHSA grant cycles continue alongside.
For your documentation: More clinics moving to PPS rates, required services and quality-measure reporting.
- 04
Payment is tying itself to outcomes
CMS's Innovation in Behavioral Health model has been running in its first states since January 2025, and a second cohort of up to five states is being selected in 2026.
For your documentation: Measures recorded at a steady cadence become revenue, not just good practice.
- 05
Agencies are combining and integrating
Overall deal volume fell in the first half of 2026, but nonprofit affiliations continued, driven by Medicaid rate pressure and the push toward integrated physical and behavioral care.
For your documentation: One platform has to hold several programs' rules, formats and payers without flattening them.
- 06
States are going their own way
States are setting different verification rules for H.R. 1 exemptions, and different laws on AI in therapy. Illinois, for example, barred AI from making therapeutic decisions in August 2025.
For your documentation: Rules need to be configured per state, and changed when a state changes them.
The checklist your security team will send us
Answered up front. Each item says whether it's included, something you configure, or shared on request.
Identity and access
Roles and seats
BuiltOwner, admin, supervisor, clinician, biller and front-desk roles; your admins manage seats and invites.
Part 2 flags
You configurePart 2 status per program and per client, with consent captured on each session.
SSO with SAML 2.0 or OIDC
PlannedOkta, Microsoft Entra ID, Google Workspace and others. On the roadmap.
SCIM 2.0 provisioning
PlannedAccounts created and removed from your directory. On the roadmap.
Data and retention
BAA
On requestAvailable, and signed before any client information flows. Your template is fine too.
Short audio retention
You configureLive audio isn't stored by Margent; uploads expire within 24 hours. You set transcript retention.
US data residency
BuiltStored in AWS us-east-1, with a US-only setting for model inference.
No training on your data
BuiltMargent doesn't train models on customer data, and the BAA says so.
Encryption
BuiltTLS in transit and encryption at rest. Customer-managed keys before the first pilot.
Oversight and assurance
Audit log
BuiltAppend-only record of signatures, edits, AI actions and approvals, with who did them.
Sample-data sandbox
BuiltA full sample practice on fictional data, plus the extension on a test EHR account. Free during evaluation.
Published evals
BuiltGrounding, audit precision and recall, and crisis-guard recall, measured and published at /evals.
SOC 2 Type I
PlannedPlanned, followed by Type II. Controls overview on request today.
Third-party penetration test
PlannedScheduled ahead of the first pilot with real client data.
Your security questionnaire
On requestWe fill in your form, or SIG Lite or HECVAT, item by item.
Products and settings
Most agencies start with notes and note checks, then add products program by program.
- NotesWrites the note from the session. Every sentence links to where it came from.
- Note checksChecks every note for issues before you sign.
- Calls & referralsScreens new clients by text chat and hands risk to a person. Phone, texting and fax are planned.
- BillingBilling codes and claim checks before you send.
- Letters & appealsLetters, reviews and appeals drafted from the chart.
- EHR connectionCopy or export to any EHR. Direct filing is in testing.
See how it works in your setting
Bring the note type you argue about
In 30 minutes we'll take a sample session to a signed note, run your payer's rules on it and show how it reaches your EHR. You'll leave with a fit assessment, a rollout timeline and a free sandbox.