A 55-minute session billed as 90834. An authorization that ran out at visit 13. A carve-out claim routed to the wrong payer. We run the full revenue cycle for outpatient behavioral health and close the gaps built into it.
Most specialties bill for a procedure with a fixed value. A large share of behavioral health claims run on time-based codes, so the minutes in a note decide the code on the claim.
Individual psychotherapy runs on three tiers: 90832 covers roughly 16–37 minutes, 90834 covers 38–52, and 90837 covers 53 minutes and up. A note that says "50-minute session" paired with a 90837 is a mismatch an auditor will find and because 90837 pays more, several payers watch it closely and send records requests when a provider bills it for nearly every visit.
Provider type matters too. Services come from psychiatrists, psychologists, LCSWs, LMFTs, LPCs, and mental health counselors, and payers reimburse each license differently. The wrong taxonomy can pay at the wrong rate or reject the claim outright.
Then there's the payer structure. Many commercial plans don't process behavioral health claims themselves. They carve those benefits out to a managed vendor such as Optum / United Behavioral Health, Carelon, Evernorth, or Magellan. The member's card shows one insurer while the claim has to route to a different payer ID entirely.
Bill behavioral health the way you'd bill medical, and clean claims deny for reasons that have nothing to do with the care delivered. That's the gap specialty billing exists to close.
Individually each is a small leak. Across a busy panel, they add up to weeks of delayed cash and write-offs that were collectible from the start.
Plans authorize a set number of sessions. Once the block runs out, every later claim denies until a new auth is on file.
Some payers cap covered visits per year or restrict how often a code can be billed enforced quietly through denials.
A 90837 without a note supporting 53+ minutes is a takeback waiting to happen.
A provider not yet credentialed with a payer, or enrolled under the wrong taxonomy, generates denials that look like coding errors but aren't.
Claims sent to the medical payer instead of the behavioral health vendor come back denied for the wrong reasons.
Secondary coverage and dual Medicare–Medicaid status stall payment when COB isn't handled up front.
From scheduling to the last dollar posted. What sets specialty billing apart is what happens before a claim ever goes out.
We verify behavioral health benefits specifically not just active coverage because a patient can have an active plan with no outpatient mental health benefit or a separate behavioral deductible. We confirm whether the plan carves benefits out to a managed vendor, check remaining authorized sessions, and flag reauthorizations before the current block runs out.
Diagnosis coding gets the same attention. Behavioral health payers reward specificity, and unspecified codes draw denials when a precise option exists. We code to the level the documentation supports a specific F32/F33 depression code, GAD at F41.1, PTSD at F43.10, ADHD in the F90 group and make sure the diagnosis actually supports medical necessity.
Catching these things on the front end is what keeps the back end clean.
Across therapy, psychiatry, and integrated care.
Each stage is tuned to how this specialty gets paid from payer-specific scrubs to denials worked by root cause.
Payer-specific edits check credentialing, taxonomy, units against time, and place-of-service 11 office, 10 home telehealth, 02 other before claims go out on a daily cycle.
An auth denial triggers a check of the patient's upcoming visits, not just one appeal. Recurring denials get fixed at the source, tracked by payer.
Payments post to the correct claim and line, adjustments apply to your fee schedule, and we flag payments below the contracted rate instead of writing them off.
We work receivables by aging and payer, prioritizing claims near timely-filing deadlines which carve-out vendors sometimes enforce more tightly than practices expect.
Substance use disorder records fall under 42 CFR Part 2, which restricts how that information is shared and changes how certain claims and records are handled. The Mental Health Parity and Addiction Equity Act requires plans to cover behavioral health on terms comparable to medical benefits useful leverage when a payer treats mental health coverage as an afterthought.
We don't write clinical notes, but we flag where documentation and coding have drifted apart most often a time-based code the recorded minutes don't support — so you can fix it before an audit does.
No platform switch required. Our team has hands-on experience with the EHR and practice-management systems common to behavioral health, and adapts to your setup rather than forcing you into ours.
Confirm your exact systems with us we work within most behavioral health EHRs and clearinghouses.
Whether you bill a handful of therapy codes or run integrated care with prescribers, testing, and group programs, we scale the work to your practice.
Yes. We identify when a commercial plan carves its behavioral health benefits out to a managed vendor and route the claim to the correct payer ID. Misrouted carve-out claims are one of the most common denials we clean up when a practice comes to us.
We track authorized session counts per patient and flag reauthorizations before the current block runs out so a patient's claims don't stall the moment they cross the authorized visit limit.
Yes. As of January 1, 2024, Medicare recognizes marriage and family therapists and mental health counselors as enrolled providers who can bill directly, following the Consolidated Appropriations Act of 2023. We handle their enrollment considerations and claims, including the correct taxonomy for each license type.
We apply the correct place-of-service code and telehealth modifier per payer modifier 95 for audio-video, FQ for audio-only where required. Medicare's behavioral health telehealth provisions, including the patient's home as an eligible location, sit on more established footing than general telehealth, but some flexibilities still depend on congressional extensions, so we stay current on what each payer requires at the time you bill.
Yes. When we see a time-based psychotherapy code the recorded session time doesn't support, or a service lacking medical-necessity documentation, we flag it before the claim goes out. We don't write your notes we make sure your coding and documentation agree.
No. We work inside the systems you already use, including SimplePractice, TherapyNotes, TheraNest, Valant, and others common to behavioral health.
We manage coordination of benefits for dual-eligible patients so primary and secondary claims cross correctly and secondary balances don't age out unpaid.
We review your aging accounts receivable, prioritize claims near timely-filing deadlines, and work recoverable balances rather than starting fresh and leaving old money behind.
If denials keep repeating, authorizations keep slipping, or you suspect payers are underpaying behavioral health claims, we'll review your current billing and show you what a specialty revenue cycle looks like for your practice.