Authorization runs out mid-episode
IOP and PHP authorizations expire on a session count, not a date. Nobody watches the counter, so the last two weeks of treatment get written off.
Mental health billing
We bill the codes that other billers get wrong.
Psychiatry, therapy, PHP, IOP and residential programs lose revenue to prior-auth gaps, downcoded 90837, and telehealth modifier errors. We work only in mental health, so we catch them before submission.
✓ No setup fee ✓ 30-day rolling contract ✓ US-based certified coders
| CPT | Payer | Finding | Status |
|---|---|---|---|
| 90837 | BCBS | 52 min documented | Clean |
| 90834‑95 | Aetna | POS 10 missing | Fixed |
| H0015 | UHC | Auth expired day 12 | Held |
| 99214+90833 | Medicare | E/M split valid | Clean |
2 corrected before submission0 rework
Where the money goes
Four denials that drain behavioral health practices
General medical billers treat mental health as an afterthought. These four account for most of the recoverable revenue we find in a first-month audit.
Your 60-minute sessions get paid as 45
Payers downcode when start and stop times aren't in the note. We flag the documentation gap before the claim leaves, not after the remit arrives.
Telehealth billed to the wrong place of service
POS 02 versus 10, modifier 95 versus GT the rules differ by payer and change yearly. One wrong pair denies the whole batch.
Denials sit in a queue nobody owns
A denial is a task, not a verdict. When appeals aren't worked on a schedule, claims quietly age past the filing window and become unrecoverable.
How we work a claim
Seven checkpoints, in order, every time
Each stage has an owner and a deadline. If a claim stalls, you see it in your weekly report before the payer clock runs out.
- 01
Eligibility
Benefits, deductible, session limits and auth requirements verified before the visit.
- 02
Authorization
Units tracked against the approved count, with renewal filed ahead of expiry.
- 03
Coding
CPT and ICD-10 assigned by certified coders against the clinical note.
- 04
Charge entry
Encounters reconciled to your schedule so no session goes unbilled.
- 05
Scrub & submit
Payer-specific edits run pre-submission. Errors get fixed, not appealed.
- 06
Posting
ERA and EOB posted line by line, with underpayments flagged against contract.
Denied → appeal in 48 hrs
- 07
A/R follow-up
Every claim over 30 days worked weekly until paid, appealed or written off with reason.
Services
Take the whole cycle, or just the part that's broken
Most practices start with denial management and A/R cleanup, then move the full cycle over once the backlog clears.
Insurance eligibility verification
Active coverage, deductible, co-pay, session caps and prior-auth requirements confirmed before the patient is seen so nothing is billed into a dead policy.
See how it works →Mental health medical coding
AAPC-certified coders assign CPT and ICD-10 against the note including E/M plus psychotherapy add-ons, testing, and crisis codes — with an audit trail.
See how it works →Charge entry
Encounters reconciled daily against your schedule. Missing documentation is flagged to the clinician before it becomes an unbillable session.
See how it works →Claim submission
Payer-specific scrubbing before the claim leaves the clearinghouse, with rejections corrected same-day rather than waiting on a remit.
See how it works →Payment posting
ERAs posted line by line and reconciled to your contracted rates, so underpayments surface instead of quietly closing the balance.
See how it works →Denial management & appeals
Every denial categorised by root cause, appealed within 48 hours, and fed back into the scrub rules so the same denial doesn't repeat next month.
See how it works →A/R follow-up
Aged claims worked on a weekly cadence by bucket, with an outcome recorded for every claim — paid, appealed, or written off with a documented reason.
See how it works →Patient billing & statements
Clear statements and a support line your patients can actually call — handled with the discretion behavioral health billing requires.
See how it works →Full revenue cycle management
All eight functions above under one team, one report, and one point of contact who knows your payer mix by name.
See how it works →Specialties
Built around your level of care
A solo therapist and a 40-bed residential program have almost nothing in common at the claim level. We bill both, differently.
Results
What changed for three real practices
Measured against the practice's own baseline in the 90 days before onboarding.
%98
Reduction in first-pass denial rate
Root cause was telehealth POS/modifier mismatch across two commercial payers. Fixed at the scrub layer in week three.
90
Recovered from aged A/R
Backlog of claims aged 90–180 days worked to resolution before the timely filing window closed.
30 days
Reduction in days in A/R
Authorization unit tracking stopped mid-episode write-offs and shortened the payment cycle.
Security & compliance
PHI handling you can put in front of an auditor
Behavioral health records carry extra protection under 42 CFR Part 2. Our controls are built for that, not retrofitted.
- ✓Signed BAA before any accessExecuted with every client and every subcontractor.
- ✓42 CFR Part 2 aware workflowsSubstance use records segregated and disclosed only with valid consent.
- ✓Encryption in transit and at restTLS 1.2+, encrypted storage, no PHI over personal email.
- ✓Role-based access & audit logsMinimum-necessary access, reviewed quarterly.
- ✓Annual HIPAA trainingDocumented for every staff member, records available on request.
- ✓Breach notification policyWritten procedure, tested, provided at onboarding.
Pricing
Percentage of collections
We're paid when you're paid. No per-claim fees, no charge on claims we don't collect.
2–4 % of monthly collections
Rate depends on claim volume, payer mix and level of care. Confirm your actual range before publishing.
- ✓ No setup or implementation fee
- ✓30-day rolling agreement Leave with 30 days' notice. Your data comes with you.
- ✓Named account lead Same person every week, reachable by phone.
- ✓ Weekly reporting included Denials by root cause, A/R by bucket, collection rate.
Switching
Live in 30 days, without a gap in cash flow
The most common reason practices stay with a biller they dislike is fear of the transition. We run the old and new cycles in parallel so nothing drops.
- 1Days 1–3 · Free A/R auditWe review your last 90 days of claims and show you, in writing, what's recoverable.
- 2Days 4–7 · Agreement & BAAScope, rate and compliance paperwork signed. No setup invoice.
- 3Days 8–14 · System accessRead/write access to your EHR and clearinghouse. We work inside your system — no migration.
- 4Days 15–21 · Parallel runNew claims through our scrub while your existing A/R keeps being worked.
- 5Days 22–30 · Full handoverBacklog absorbed, first weekly report delivered, account lead introduced.
Coverage
Nationwide, with state-specific Medicaid experience
Medicaid behavioral health rules vary sharply by state. These are the programs we work in most often.
Questions
What practices ask before switching
How much do mental health billing services cost?
Most behavioral health billing companies charge a percentage of collections, typically between 2% and 4%. The rate depends on claim volume, payer mix, and level of care residential and IOP billing is more labour-intensive than outpatient therapy. We quote a fixed percentage after reviewing your last 90 days of claims, and we don't bill on claims we fail to collect.
Do I have to change my EHR or practice management system?
No. We work inside the system you already use SimplePractice, TherapyNotes, Valant, Tebra, AdvancedMD, athenahealth and others. You grant us role-based access under a signed BAA. There is no data migration and no new software for your clinicians to learn.
How long does it take to see a change in collections?
Clean-claim improvements show up in the first payment cycle, usually 2–4 weeks. Recovery from aged A/R takes longer, because appeals move at the payer's pace expect 60–120 days for the bulk of a backlog, and note that any claim already past the timely filing window is generally unrecoverable.
Why does mental health billing need a specialist?
Behavioral health has rules general medical billing doesn't: time-based psychotherapy codes that get downcoded without documented start and stop times, session-count authorizations for IOP and PHP, per-diem codes for residential care, telehealth place-of service rules that differ by payer, and 42 CFR Part 2 restrictions on substance use records. A biller who mostly handles primary care will not have seen most of these.
Is my patient data secure?
We sign a Business Associate Agreement before accessing any system. PHI is encrypted in transit and at rest, access is role-based and logged, staff complete documented annual HIPAA training, and we maintain a written breach notification procedure that we provide at onboarding.
What happens if I want to leave?
Thirty days' written notice, no exit fee. Your data lives in your own EHR and clearinghouse throughout, so there is nothing to extract from us. We work outstanding claims through the notice period and hand over an open-items list.
Do you bill Medicare and Medicaid for behavioral health?
Yes. Medicare covers services from psychiatrists, clinical psychologists, clinical social workers, and since 2024 marriage and family therapists and mental health counselors who have enrolled. Medicaid behavioral health rules are set state by state, so eligibility and covered codes differ; we confirm the specific rules for your state during the audit.
