Every step from the first benefit check to the last reconciled payment falls to us, so revenue stops escaping at the exact points where PMHNP practices usually lose it.
Ahead of the first appointment, we confirm active coverage, verify behavioral health benefits, and flag deductible and co-insurance status. For psychiatric NP care specifically, we check whether the plan requires the nurse practitioner to be in-network under their own NPI, whether medication-management visits carry their own limits, and whether a service needs prior authorization. Settle coverage before the visit and you sidestep a denial that would otherwise surface weeks down the line.
This is where most PMHNP practices quietly hemorrhage time and money. We enroll your nurse practitioners with Medicare, Medicaid, and commercial panels, build and maintain CAQH profiles, track re-credentialing dates, and keep NPI and taxonomy details consistent from one payer to the next. Clean enrollment is the line between an NP billing in week one and an NP sitting idle for three months.
Our certified coders assign the right E&M level (99202 through 99215) for medication management, the correct diagnostic evaluation code (90791 or 90792), and the time-based psychotherapy and add-on codes when a session blends both. Each choice is matched to the documented time, complexity, and medical necessity, with the modifiers that telehealth and place of service call for. Get the code right and you protect the payment and shield the practice from a clawback.
Every claim passes through scrubbing edits before it leaves the door, where we catch missing modifiers, telehealth place-of-service slips, supervision-rule mismatches, and the payer-specific quirks unique to nurse practitioner billing. Electronic submission to commercial, Medicaid, and Medicare payers keeps first-pass acceptance high and the payment cycle short.
When a PMHNP claim bounces a missing authorization, a scope-of-practice flag, an incident-to condition that wasn't met, a time-versus-code mismatch we find what tripped it, assemble an appeal backed by the chart, and correct whatever caused it so the same denial doesn't come knocking the following month.
Practice owners get a straight financial read: collection rates, denial trends sorted by payer, days in AR, live credentialing status, and reimbursement broken out provider by provider. Numbers like these turn guesswork into decisions that defend your bottom line.
We gather and confirm demographics, insurance details, referral sources, and authorization needs right at the front end, laying an accurate foundation that heads off costly mistakes before a single claim goes out.
We confirm active coverage, behavioral health benefits, NP network status, deductible and co-insurance amounts, and per-payer visit limits ahead of each appointment, so every visit your nurse practitioners deliver is genuinely billable.
We translate progress notes and psychiatric records into precise CPT, ICD-10-CM, and HCPCS codes, then confirm the documentation supports the level billed and satisfies the supervision and medical-necessity standards that govern nurse practitioner services.
We send scrubbed claims electronically, watch their status in real time, and pursue pending, delayed, or denied claims before they age, driving the fastest realistic reimbursement for your practice.
We post payments accurately, reconcile EOBs against contracted rates, surface underpayments and write-off discrepancies, and keep audit-ready records so your accounts stay balanced and current.
We document every medication-management visit, diagnostic evaluation, and psychotherapy session, making sure no E&M level or psychotherapy add-on slips past uncaptured. Recurring weekly and monthly appointments add up quickly, and we make certain each one gets billed.
Our team submits compliant claims and stays on every outstanding, pending, or denied claim across commercial, Medicaid, and Medicare payers, lifting net collections and squeezing reimbursement timelines tighter.
We study the denial patterns tied to your specific payer mix and provider type, build appeal packages supported by clinical notes, and recover dollars that solo and group PMHNP practices routinely forfeit without a partner working their AR every single day.
Psychiatric nurse practitioners lean on telehealth harder than almost any specialty, and plenty hold licenses in more than one state. We manage the place-of-service codes, telehealth modifiers, and state-by-state payer rules that virtual psychiatric care depends on, so a session billed across state lines pays the same as one delivered down the hall.
Our coders stay current on the rules that decide how NP services reimburse the 85% physician-fee-schedule rate when billing under the nurse practitioner's own NPI, incident-to and split/shared conditions, controlled-substance and DEA documentation, mental health parity requirements, 42 CFR Part 2 protections for substance-use records, and the telehealth guidance that keeps shifting.
We work inside the systems your staff already use, from TherapyNotes and SimplePractice to the other leading platforms, and pair them with live AR dashboards and plain-language reporting. You get full outsourced PMHNP billing without abandoning the software your team knows by heart.
Billing built specifically for nurse practitioners
our certified billers and coders bring hands-on command of E&M and psychotherapy CPT codes, time-based documentation rules, incident-to and split/shared logic, and the credentialing steps that decide when an NP can start collecting. The payoff is accurate, compliant claims across practices of every size.