TherapyNotes billing services
Every claim depends on a chain that starts at the calendar and ends at a signed note. Break a link and the claim never appears — no error, no alert, no entry on your aging report. We work inside your account and keep that chain intact.
● Practice Biller access under a signed BAA. Your data never leaves TherapyNotes.
How a claim is born
Stall at the gate and nothing downstream happens. Unbilled services don't age, so they never surface on an A/R report.
Overview of the software
It was built for therapists, not for billers. That design choice is exactly why so many practices leave money in it.
TherapyNotes is a behavioral-health-specific EHR and practice management platform. Unlike general-purpose systems that bolt on a behavioral health module, it was designed around how psychotherapy and psychiatry practices actually operate: recurring weekly sessions, discipline-specific note templates, supervision hierarchies, sliding scale fees, and a mix of insurance and self-pay clients in the same caseload.
Scheduling, documentation, insurance billing, client portal, telehealth, and reporting live in one account. Claims route through an integrated clearinghouse connection (Claim.MD), supporting electronic submission to over 2,000 payers, real-time eligibility for a large subset of them, electronic remittance advice, and a paper mailing service for payers that still require a printed CMS-1500.
The service type you pick when booking determines which note template opens. The note determines the CPT code. The signature releases the claim.
This is a genuinely good design. It enforces documentation discipline and prevents billing for services with no supporting note. But it also means documentation backlog and revenue backlog are the same problem.
A practice with 60 unsigned notes doesn't have a charting problem. It has an unbilled A/R problem that hasn't appeared on any report yet because unbilled services don't age. They don't exist.
The structural fact
A billable claim in TherapyNotes is generated by a completed and signed note attached to a scheduled appointment. Most billing companies discover what that means three months into an engagement. We start there.
Our software support services
Not in a parallel system. Not in exported spreadsheets. In your TherapyNotes account, where you can open it any hour and see exactly what we see.
Default billing methods for in- and out-of-network payers, per-payer overrides, service codes and rate schedules, sliding scale, telehealth place-of-service defaults, statement settings, and payer IDs.
Enrollment is not credentialing. Being paneled with a payer doesn't connect your account to it. We complete the paperwork payer by payer and track the multi-week approvals.
Notes due, claims ready, co-signatures pending, ERAs waiting. Left alone it becomes noise everyone stops reading. We work it as a checklist every business day.
Real-time checks where supported, portal or phone where not. We look for what generic verification misses: behavioral health carve-outs, telehealth parity, session limits, deductible application.
Billed code checked against what the note documents — session duration against time-based codes, add-on eligibility, modifiers, place of service.
Batch reviewed and filtered by payer before release, not clicked through. Non-EDI payers route via the paper mailing service so you still get status tracking.
Rejections never reached adjudication — fixed and resubmitted, usually same day. Denials went through it and need correction, appeal, or a documented write-off.
Assisted posting pulls the data; it doesn't decide whether the payer adjudicated correctly. We reconcile allowed amounts against your contracted rates, line by line.
Root-cause analysis, corrected claims, formal appeals with documentation, and payer-level pattern tracking so the same denial doesn't return next month.
Accurate patient responsibility, statements on a set cadence, payment plan coordination, and handling the balance questions clinicians shouldn't field mid-session.
Systematic aging review, payer follow-up, and timely-filing protection — including the unbilled bucket standard A/R reports cannot see.
CAQH maintenance, initial applications, revalidations, and re-credentialing calendars, coordinated with payer setup so panels and EDI connections stay in sync.
How we use this software
Most billing companies describe their process generically because their process is generic. Ours is shaped by how TherapyNotes actually behaves.
Before touching a claim, we pull outstanding documentation. Every unsigned note is a service rendered that will never generate a claim and is aging toward a filing deadline. A six-clinician practice at 25 sessions each per week can hold $8,000–$12,000 in unbilled services from a two-week lag — visible on no report at all. We flag them by clinician with dates of service and days remaining.
A supervisee's note generates a co-signature task before the service can bill under the supervisor's credentials. We track these separately, because a note that's signed but not co-signed looks complete on a documentation report and is still unbillable.
Our highest-value review: documented session duration against the billed time-based code. If the note shows 47 minutes and the claim carries 90837 (53 minutes and over), that claim gets downcoded, denied, or paid now and recouped later in an audit. Where the pattern is systematic, we take it back to the clinician instead of fixing the same claim every week.
Different payers fail on different things. Many state Medicaid plans require license-level modifiers. Some commercial plans reject on rendering-to-billing provider configuration. Telehealth fails on place of service more than practices realize — POS 10 and POS 02 are reimbursed differently, and defaulting everything to 02 costs money on every session.
We verify allowed amounts against contracted rates before applying anything. A payer paying $8 under contract on 40 sessions a month is a $3,840 annual leak that posts cleanly and triggers no alert. We also check that CO-45 adjustments and PR-1/PR-2/PR-3 responsibility landed in the right buckets — misapplication here corrupts statements and generates complaints that reach the clinician.
Sorted by cause, not dollar amount. CO-197 means a front-end process broke and will break again. CO-27 means eligibility wasn't re-verified. CO-29 means the note-to-claim chain failed weeks ago. We fix the claim and the process that produced it.
Key features we help you utilize
Most practices treat it as a reminder widget. We treat it as the practice's work queue and drive it to a manageable steady state.
Because the service type chosen at scheduling determines the note template, scheduling errors become documentation errors become billing errors. Training front-desk staff on this dependency eliminates a surprising volume of rework.
Supervision billing can be set globally and overridden per payer — necessary, because payers differ on accepting incident-to services from pre-licensed clinicians. Set once at user level, you get blanket denials from the payers that don't allow it.
Real-time checks cover many payers, not all. We run a hybrid workflow with re-verification at plan year turnover — the January and July windows where terminated-coverage denials spike.
Per-client copay, coinsurance, deductible, sliding scale, and bill-to configuration, plus authorization units tracked against sessions used — so renewal is requested before sessions are delivered uncovered.
Medicare crossovers often generate automatically after primary posting. Commercial secondaries usually need manual submission with the primary EOB attached. We handle both instead of letting balances roll silently to the patient.
For private-pay and OON practices: accurate superbills and courtesy OON claim submission, so clients aren't left filing their own reimbursement paperwork.
Configured so copays collect at time of service and portal statements are clear enough that clients don't ask their therapist about them.
Software workflow explained
The order matters here — each step depends on the one before it. Phase B is where practices lose money without knowing it.
Benefits for healthcare practices
Daily unsigned-note tracking converts documentation backlog into submitted claims before filing deadlines close.
Pre-submission review of duration-to-code alignment, modifiers, place of service, and supervision setup means fewer claims come back at all.
Tracking reasons by payer surfaces patterns — a plan that always needs authorization, a payer that rejects a modifier combination — and fixes the process, not just the claim.
Consistent follow-up on a defined cadence, rather than whenever someone finds the time.
Proper adjustment posting means statements are right the first time, which keeps billing conversations out of the therapy room.
The most expensive person in the practice should not be researching a CO-16 denial.
A signed Business Associate Agreement and role-scoped Practice Biller access. Minimum necessary, inside your system, with no PHI exported to platforms you didn't choose.
Because the notes and the claims tell the same story.
Why Mental Health Billing
Mental health billing has its own failure modes: time-based psychotherapy codes, supervision rules that vary by payer and state, carve-outs, session limits, telehealth parity. A generalist who also handles orthopedics will learn these on your claims.
Your data stays in TherapyNotes. Log in at any hour and see every claim status, every posted payment, every denial we're working. No monthly PDF you're asked to trust.
TherapyNotes has excellent workflow enforcement and dependable claim submission. Its reporting depth is limited compared to competitors. We say so and fill that gap ourselves rather than pretending the built-in reports answer questions they don't.
If intake staff are selecting the wrong service type at scheduling, correcting the resulting claims forever isn't a solution. We find the origin and train it out.
You know what we handle, what stays with your staff, and what our reporting shows — before you sign anything.
We don't publish guaranteed collection rates or denial-reduction percentages. Unverifiable numbers damage trust with practice owners who've heard them all before.
Specialties we support on this platform
From solo practitioners to multi-location behavioral health organizations.
Frequently asked questions
No. We typically work under a Practice Biller role, which provides the billing access we need without unnecessary access to clinical documentation. Where we also handle scheduling coordination, we scope permissions accordingly. Access is defined in writing before onboarding and covered by a Business Associate Agreement.
Because a claim is produced by a completed and signed note attached to a scheduled appointment. If the note is unsigned or a supervisee's note is signed but not co-signed — no claim enters the submission queue. This is the most common cause of missing revenue in the platform, and it's invisible on A/R reports because unbilled services never age.
Almost always because clearinghouse enrollment and payer credentialing were confused. Being paneled establishes your contract. EDI and ERA enrollment establishes the electronic connection between your TherapyNotes account and that payer. Both are required, and enrollment can take several weeks. We complete and track this separately for each payer.
Usually, within limits. We audit unbilled services, open claims, and denials, then work backward — prioritizing anything approaching a timely filing deadline. Claims past the filing window generally can't be recovered, which is why we start every engagement with an aging and unbilled review rather than waiting for month one to close.
Through the supervision settings, configured per payer. Payers differ on whether they accept incident-to services from supervised clinicians, so a single global setting produces denials from the ones that don't allow it. We map your contracts, configure supervision billing payer by payer, and monitor the co-signature queue — an un-co-signed note can't bill under the supervisor's credentials.
We review the billing-relevant elements: session duration against time-based codes, diagnosis presence and specificity, add-on code eligibility, modifiers, and place of service. We don't write or alter clinical content. When we see a recurring mismatch — such as 90837 billed on consistently sub-53-minute sessions — we bring it to the clinician directly, because that pattern creates real audit exposure.
Place of service and modifier requirements vary by payer. POS 10 (patient at home) and POS 02 (patient at a non-home location) aren't interchangeable, and many payers reimburse them at different rates. Some also require modifier 95 or a state-specific equivalent. We set correct defaults and verify payer-specific requirements rather than applying one setting to everyone.
Monthly reporting covering gross charges, collections, net collection rate, first-pass acceptance, A/R aging by bucket and payer, top denial reasons with root cause, unbilled service exposure, and per-clinician productivity. The platform's built-in reporting is serviceable but limited in analytical depth, so ours supplements it rather than repeating it.
Yes. Private-pay and out-of-network practices still need accurate superbills, courtesy OON claim submission, sliding scale configuration, card processing setup, and clean statements. Several of our clients bill almost no insurance and still see meaningful benefit.
Typically two to four weeks for a full transition. Week one is an audit — account configuration, enrollment status, aging, and unbilled backlog. Weeks two and three cover access setup, outstanding enrollments, and configuration corrections. By week four we're running daily operations. Practices with significant backlog take longer to reach steady state, and we tell you that estimate before you commit.
Get started
Most practices we speak with are surprised by one number: the dollar value of services delivered that never became claims. It doesn't appear on an aging report. It doesn't trigger an alert. It sits in unsigned notes and un-co-signed documentation until the filing window closes.
We'll review your account and tell you what we find — unbilled exposure, aging distribution, denial patterns, configuration errors, enrollment gaps — before you commit to anything.
Serving solo practitioners, group practices, and multi-location behavioral health organizations nationwide.