For substance use disorder care, the ASAM Criteria are how payers decide whether a level of care is appropriate, and the Fourth Edition (2023) is now the standard. Tools in this space fall into two groups: assessment tools that help you determine the right level of care across the six ASAM dimensions, and documentation-compliance tools that make sure the ASAM level you chose is justified and defensible before the claim goes out. The best ASAM assessment and level-of-care tools for 2026 are below, starting with the assessment platforms and including the AI documentation-compliance layer that protects the claim.
The short version
- The ASAM Criteria Fourth Edition (2023) is now the standard, and states like Kentucky and Illinois have adopted it for Medicaid SUD services.
- Assessment tools (ASAM CONTINUUM, BestNotes, DrugEval) help determine the right level of care across the six dimensions.
- Claims are denied less for the wrong level than for documentation that does not justify it, which is where compliance layers help.
- Many programs pair an assessment tool with a documentation-compliance layer so the level is both chosen and defended.
How we chose
We separated two jobs that often get conflated. First, assessment: does the tool help a clinician evaluate the patient across the six ASAM dimensions and arrive at a defensible level of care? Second, documentation compliance: does the tool make sure that level is justified in the record, with the dimensional findings and the why-not-a-lower-level reasoning payers look for, before the claim is submitted? We favored tools that are explicit about the Fourth Edition and about how their output holds up in utilization review.
What to look for
These tools do one of two jobs, and it helps to know which you need:
- Assessment: does it help a clinician evaluate the patient across the six ASAM dimensions and arrive at a defensible level of care?
- Documentation compliance: does it make sure that level is justified in the record and will survive utilization review before the claim goes out?
- Fourth Edition alignment: is it explicit about the 2023 ASAM Criteria that most large payers now reference?
- Level vs hours: does the level billed match the hours actually delivered?
- How the output holds up: does the recommendation translate into documentation a reviewer will accept?
ASAM tools at a glance
| Tool | Best for | AI-driven? |
|---|---|---|
| ASAM CONTINUUM | Authoritative ASAM assessment | Partial |
| BestNotes | EHR with native ASAM assessment | Partial |
| DrugEval | Efficient ASAM evaluations | Partial |
| Behave Health | Configurable LOC documentation | Partial |
| Adentris | AI ASAM documentation compliance | Yes |
Capabilities and pricing change quickly in this market, so confirm current details with each vendor before you decide.
1. ASAM CONTINUUM
Best for: The authoritative electronic ASAM assessment with clinical decision support for level-of-care.
How it works: ASAM CONTINUUM is ASAM's own electronic assessment tool. It guides a structured assessment across the six dimensions and uses a computerized clinical decision support system to generate a level-of-care recommendation, giving programs a defensible, standardized basis for placement.
Key capabilities: Six-dimension assessment, computerized decision support, standardized level-of-care recommendation.
AI: Clinical decision support system (CDSS).
Best fit: Programs that want the authoritative, standardized ASAM assessment basis.
Strengths:
- ASAM's own electronic assessment tool
- Structured six-dimension assessment with computerized decision support
- Produces a defensible, standardized level-of-care recommendation
Watch-outs:
- An assessment tool, not a documentation-compliance or claim layer, so it does not audit whether the note defends the level
- Partial AI
2. BestNotes
Best for: Behavioral health programs wanting an EHR with native ASAM CONTINUUM and level tracking.
How it works: BestNotes is a behavioral health EHR with native ASAM CONTINUUM and CO-Triage tools and robust ASAM level tracking, so assessment and the record live in one system.
Key capabilities: EHR with native CONTINUUM, CO-Triage, ASAM level tracking.
AI: Embedded assessment tools.
Best fit: Behavioral health programs that want an EHR with native ASAM assessment and level tracking in one system.
Strengths:
- Behavioral health EHR with native ASAM CONTINUUM and CO-Triage
- Robust ASAM level tracking
- Assessment and the record live together
Watch-outs:
- An EHR of record, so adopting it is a migration
- Embedded assessment rather than an independent real-time compliance reviewer of the claim
3. DrugEval
Best for: Programs wanting efficient, structured ASAM-based evaluations.
How it works: DrugEval builds on the ASAM Criteria to deliver structured evaluations, with a step-based process designed to address all six dimensions thoroughly and efficiently.
Key capabilities: Structured ASAM evaluations across all six dimensions.
AI: Guided evaluation workflow.
Best fit: Programs that want efficient, structured ASAM-based evaluations.
Strengths:
- Structured evaluations built on the ASAM Criteria
- A step-based process covering all six dimensions
- Designed for efficiency
Watch-outs:
- An evaluation workflow, not a claim-defense or compliance layer
- Confirm how its output maps into your EHR and utilization review
4. Behave Health
Best for: Programs wanting configurable level-of-care documentation across the continuum.
How it works: Behave Health supports configurable level-of-care labels and documentation workflows across outpatient, IOP, PHP, residential, and inpatient programs within its EHR and billing platform.
Key capabilities: Configurable level-of-care labels, continuum workflows.
AI: Platform automation.
Best fit: Programs that want configurable level-of-care documentation across the continuum.
Strengths:
- Configurable level-of-care labels and documentation workflows
- Coverage from outpatient through inpatient
- Part of an EHR and billing platform
Watch-outs:
- Platform automation rather than a dedicated ASAM assessment engine or a real-time compliance reviewer
- All-in-one adoption is a migration
5. Adentris
Best for: Making sure the ASAM level-of-care justification is documented and defensible before the claim.
How it works: Adentris does not perform the ASAM assessment; it makes sure the assessment holds up on the claim. Its AI reviews SUD documentation in real time and checks the ASAM logic before submission: whether the level is justified across the six dimensions, whether the note explains why a lower level would not meet the need, and whether the level billed matches the hours delivered, then drafts the correction. It runs on any EHR.
Key capabilities: Real-time ASAM documentation review, six-dimension checks, drafted corrections, 42 CFR Part 2 controls, appeals module.
AI: Yes, AI documentation compliance that defends the ASAM level of care.
Best fit: Programs that want the ASAM level justified and defensible on the claim before submission.
Strengths:
- Real-time check of the ASAM logic: six dimensions, why-not-lower-level, and level-vs-hours
- Drafts the correction before submission
- Runs on any EHR, with 42 CFR Part 2 controls and an appeals module
Watch-outs:
- It does not perform the assessment itself; it defends the level you chose
- It pairs with an assessment tool rather than replacing it
How to choose
Match the tool to the job:
- The authoritative standardized assessment: ASAM CONTINUUM.
- An EHR with native CONTINUUM and level tracking: BestNotes.
- Efficient, structured ASAM-based evaluations: DrugEval.
- Configurable level-of-care documentation across the continuum: Behave Health.
- Defending the ASAM level on the claim before submission: Adentris.
Many programs pair an assessment tool with a documentation-compliance layer, so the level is both chosen well and defended in the record.
Common pitfalls to avoid
- Conflating assessment with documentation compliance. Choosing the level and proving it on the claim are different jobs.
- Asserting a level without tying it to the six dimensions. Reviewers want the dimensional reasoning.
- Leaving out the why-not-a-lower-level reasoning. This is a frequent denial reason.
- Billing a level the hours do not support. The level delivered must match the level billed.
- Using an outdated ASAM edition for a payer that expects the Fourth Edition.
How Adentris helps
Adentris reviews SUD documentation in real time and checks the ASAM logic before the claim goes out: whether the level of care is justified across all six dimensions, whether the note explains why a lower level would not meet the need, and whether the level billed matches the hours delivered. To see it on your own charts, book a 30-minute call with our team.
Related reading
- AI chart review tools for behavioral health
- Adentris vs Brellium
- Behavioral health payer audit readiness solutions
Frequently asked questions
What is the difference between an ASAM assessment tool and a documentation-compliance tool?
An assessment tool (like ASAM CONTINUUM) helps a clinician determine the right level of care across the six dimensions. A documentation-compliance tool (like Adentris) makes sure that level is justified in the record and will survive utilization review before the claim is submitted. Many programs use both.
Which ASAM edition should we use?
The Fourth Edition, published in 2023, is now the standard for most large payers, Medicaid programs, and accreditors, and states such as Kentucky and Illinois have adopted it for Medicaid SUD services. Confirm each payer's expectation, since adoption timelines vary.
Why do SUD claims get denied even when ASAM criteria are met?
Usually because the documentation does not show the work: the level is asserted without tying it to the six dimensions, the note does not explain why a lower level would be insufficient, or the level billed does not match the hours delivered. The care may be appropriate, but the record does not justify it.
Do we need both an assessment tool and a compliance layer?
Many programs do. The assessment tool helps choose a defensible level across the six dimensions; the compliance layer makes sure that choice is documented well enough to survive utilization review and get paid.
Has the ASAM Fourth Edition changed what payers expect?
It reaffirmed the six-dimension, level-of-care framework and is now the standard most large payers and Medicaid programs reference. The core documentation expectation is unchanged: tie the level to the dimensions and explain why a lower level will not do.
About the author: Sergey Yudovskiy is the Chief Product Officer of Adentris, which builds AI for revenue integrity and documentation compliance in behavioral health and substance use disorder care.
