Mental Billing Services handles remote billing for New Jersey mental health and substance use practices, from eligibility and payer routing through coding, denials, posting, and A/R follow-up.
Help at each step of the revenue cycle, with the scope set around your specialty, payer mix, and provider structure.
Confirm coverage, MCO assignment, behavioral health benefits, copays, and deductibles before the visit is billed.
Check CPT, HCPCS, and ICD-10-CM codes, units, modifiers, place of service, and provider details against the payer's rules.
Track approvals, dates, units, limits, and supporting records, including substance use requests that go through NJSAMS.
Scrub and send claims through the right channel, then clear clearinghouse and payer rejections.
Post ERAs and EOBs, record adjustments, and flag underpayments, including out-of-network rate questions.
Find the cause of each denial, file corrections or appeals before the deadline, and follow open balances to an outcome.
Behavioral health claims can go to a commercial carrier, to one of five NJ FamilyCare plans, or to Medicaid fee-for-service. The member's enrollment on the date of service decides which.
About 95 percent of NJ FamilyCare members are enrolled in managed care, so most behavioral health claims now go to a plan instead of to the state.
Aetna Better Health, Fidelis Care, Horizon NJ Health, UnitedHealthcare Community Plan, and Wellpoint each run their own portal, authorization steps, and claim rules. Claims go to the plan the member is enrolled in.
A smaller share of members stay outside managed care, including some with presumptive eligibility. Their mental health authorizations go to county Medical Assistance Customer Centers, and claims follow NJMMIS rules.
NJMMIS enrollment does not put a provider in a plan's network. Each plan credentials and contracts separately, and individuals and agencies credential under different NPIs.
New Jersey is moving behavioral health services into NJ FamilyCare managed care in stages, so the billing route can differ by service. We check each service against current state guidance.
Outpatient mental health counseling, partial hospitalization and partial care, and substance use outpatient, intensive outpatient, and partial care services moved to managed care. Transition protections are being lifted plan by plan.
Presumptive and definitive drug testing tied to a substance use diagnosis now bills to the member's plan. Claims need the ordering provider's name and NPI.
Substance use residential treatment, medically monitored withdrawal management, and opioid treatment programs are scheduled to follow. The scope of later phases is still being set.
We start with how your practice runs, then build a repeatable billing routine around it.
Talk through specialty, payer mix, provider setup, and the billing problems that need attention first.
Confirm eligibility, plan assignment, behavioral health benefits, and authorization needs.
Identify the payer, Medicaid route, provider requirements, and documentation that apply to the service.
Review codes and claim data, send claims through the right channel, and watch acknowledgments.
Post remittances, reconcile payments, and work denials through correction or appeal.
Track open claims and keep the practice informed about pending payer actions and filing limits.
Our remote billing is built for behavioral health. Enrollment, authorization, and claim routing differ by service, so we confirm scope before work begins.
Clear updates on claims, payer responses, outstanding balances, and the next steps needed to keep your revenue cycle moving.
✓ Clear updates on open claimsShort answers about remote behavioral health billing in New Jersey.
Remote help with eligibility checks, coding and charge review, claim submission, payment posting, denials and appeals, A/R follow-up, and patient statements. The scope is set during the billing review.
To the member's plan for services that have moved into managed care, and to fee-for-service for members and services that have not. The member's enrollment and the date of service decide, so both are checked before submission.
Usually both. NJMMIS enrollment does not make a provider in-network with any plan. Each of the five plans credentials separately, and contracting is its own step. Physicians can use a single universal credentialing form, while other providers apply to each plan.
During the transition, plans had to approve authorizations automatically and pay out-of-network providers at fee-for-service rates. Each plan lifts those protections on its own schedule. After that, a plan can deny an authorization on medical necessity, and out-of-network payment may follow a single case agreement. We check each plan's current status before billing.
The plans use 180 days from the date of service for the first submitted claim, and inpatient claims count from discharge. A contract exception can change that, so we check the plan's manual for each claim.
Start with a practical look at your payer mix, claim routing, denials, and open receivables. We do not promise guaranteed reimbursement.
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