Epic
Epic Services For Psychiatry, PMHNP, Psychology, And Behavioral Health Practices.
Epic’s Resolute Professional Billing runs on work queues, and queues only move when someone works them. For behavioral health groups, we work charge review, claim edits and follow-up inside your instance, alongside the team you already have.
Why AdvanceAPractice
What We Bring To Billing In Epic
Behavioral Health Billing Experience
Our billing work centers on psychiatry, PMHNP and psychology services and the payer rules behind them, which an out-of-the-box build doesn’t usually reflect.
A Bad Handoff Becomes A Queue Item
In Epic, a bad handoff upstream becomes a queue item downstream. Scheduling, documentation, coding and submission have to line up, or the account stops in charge review or a claim edit.
In A Rules-Driven Build, Things Fail Together
We handle denials, telehealth modifiers, eligibility edits and credentialing as parts of one system, because in a rules-driven build they fail together.
Where Behavioral Health Billing Gets Complicated
Where Behavioral Health Accounts Get Stuck In Epic
Payer Rules Have To Live In The Edit Logic
Visit limits, covered services, telehealth rules and place-of-service requirements vary across commercial plans, and Medicaid plans and Medicare have their own. All of it has to live in the edit logic. Authorization is mostly a medication and Spravato question in outpatient mental health, and payers still don’t agree on it.
A Note That Doesn’t Match Fails An Edit
When the diagnosis, medical necessity language, note timing and service details don’t agree, the claim fails an edit or goes out weak. Either way, somebody’s working it twice.
Unenrolled Providers Land In Follow-Up
Enrollment delays and billing readiness gaps hurt most while a group is growing. A provider who isn’t set up with a payer yet generates accounts that land in follow-up and sit there.
What We Check
What We Check On Every Epic Account
We work the parts of the cycle that decide reimbursement, from eligibility and benefits through telehealth place of service, charge review, claim edits and denial follow-up, down to aging accounts.
- Eligibility and benefits checked by service type before the visit, not after the denial
- Authorizations and concurrent reviews tracked by plan, so a visit doesn’t go out on an approval that’s already run out
- Telehealth place of service and modifiers set the way each payer wants them, not one default for every plan
- Psychotherapy add-on codes billed with a med-management visit, checked against payer rules before the claim goes out
- Denials appealed while the appeal window’s still open, and aging A/R worked claim by claim
- Patient responsibility posted from the remittance, so a patient doesn’t get a bill for what the plan should’ve paid. Your practice mails its own patient statements.
- Credentialing and payer enrollment tracked together, so a new provider doesn’t fill a schedule before they can bill for it
Beyond The Software
What’s Changing For Behavioral Health In Health Systems
Behavioral Health Is Moving Into Primary Care
Health systems keep folding behavioral health into primary care and specialty clinics. That’s more departments and more handoffs, and the build has to handle all of them.
A Messy Routine Becomes More Queue Items
Electronic eligibility checks, claim status requests and provider data updates only cut work when someone’s built a routine around them. In a large Epic build, a messy routine just turns into more queue items.
Provider Type Rules Keep Changing
The billing rules for each behavioral health provider type keep changing. When they do, enrollment, build and claim logic all need updating, or those accounts start stacking up in follow-up.
Best Fit
Epic Groups We Fit Best
It’s most useful for psychiatry practices, PMHNP teams, psychology practices and behavioral health groups inside larger organizations that know denials, telehealth errors or inconsistent documentation are dragging on collections.
- Practices where an unpaid claim sits until somebody happens to notice it
- Psychiatry and PMHNP practices billing med management with a psychotherapy add-on in the same visit
- Behavioral health teams whose telehealth place of service or modifier depends on who scheduled the visit
- Growing practices where a new provider can start seeing patients before anyone’s set them up to bill
Epic Workflow
How Billing Works Inside Epic
Epic is an enterprise electronic health record used by large health systems and integrated provider organizations. Epic’s professional billing module, Resolute Professional Billing, handles the revenue cycle for clinician-billed services. Charges start in clinical documentation. They don’t reach the payer as a clean claim until they’ve passed a series of rules-driven checkpoints.
Billing in Epic is built around the work queue. There’s no single billing screen. Resolute routes accounts into queues that hold charges or claims meeting specific criteria, like a missing modifier, a coverage mismatch or a payer rejection, and each queue is a worklist a biller has to review and resolve. Knowing which queue an account’s sitting in, and why, is most of the daily work.
Charge Capture
Charges come from what clinicians enter: encounters, notes and orders. In a well-configured build much of it flows automatically from the chart, so the codes on a claim start with what the provider documented at the point of care.
Charge Review Work Queues
Before a charge becomes a claim, it lands in charge review. These queues hold charges that need a human check, like a missing or conflicting code, an absent modifier or a documentation gap. Billers reconcile the charge here, so the claim that’s built from it starts out right.
Claim Edit Work Queues
Once charges pass review, Epic assembles a claim and runs it against edit rules. A claim that fails an edit stops in a claim edit queue, whether it’s a payer-specific format issue, an eligibility flag or a coding combination the rules won’t accept. Billers resolve the edit so the claim can go out clean.
Follow-Up / Denial Work Queues
After submission, accounts the payer denied, underpaid or still hasn’t paid past the expected timeframe route into follow-up and denial queues. That’s where aging accounts receivable lives. Somebody has to work, appeal, correct or rebill each one before the money comes in.
The Trade-Off
Why Epic Adds Complexity For Behavioral Health Groups
Epic’s strength is how configurable it is. The flexibility that lets a health system fit the platform to its specialty mix also means it only works as well as it’s built and maintained. For behavioral health groups, a handful of things decide how much manual work lands on the billing team.
- Configurability is both power and tax. Epic can model almost any payer or service-line detail, but someone has to build every rule, queue and routing decision on purpose and keep it current. An out-of-the-box build won’t usually match how behavioral health billing works.
- behavioral health payer rules must live in the edit rules. Time-based psychotherapy codes, add-on codes, telehealth modifiers, place-of-service requirements and authorization rules for medications all vary by payer. If charge review and claim edit logic don’t reflect them, claims either stop in queues or go out wrong.
- Work-queue volume can outpace staffing. Every account that fails an edit or gets denied becomes a worklist item. When the queues grow faster than the team working them, accounts age, follow-up slips and revenue sits unresolved, and that’s a staffing problem rather than a software one.
- Front-end accuracy matters even more. Verified eligibility, prior authorization where a medication needs it, and correct coding up front prevent edits and denials later. In a system this rule-driven, nothing keeps claims out of the queues like a clean front end.
Our Approach
Working Inside Your Epic Instance
A billing partner doesn’t replace Epic or ask you to switch systems. We work inside the Epic instance your organization already runs, logging into Resolute Professional Billing and working the same queues your team does. We clear charge review and claim edit worklists, resolve denials and follow up on aging accounts so revenue doesn’t stall in the system.
Once the daily worklists are clear, we look at the patterns behind them, like why claims keep landing in a particular queue or which denial trends trace back to the same root cause. We also work aged accounts down so accounts receivable stays current. If you want that work run for you, it’s our Ongoing Billing, priced by practice size (see medical billing prices by practice size). If the same rule keeps sending accounts to the same queue, an Automation Program builds one workflow from start to finish in your own systems, with the tracker your team works from and one dashboard, for $5,000, or four monthly payments of $1,250.
- We work the charge review, claim edit and follow-up/denial work queues alongside your existing team.
- We trace recurring denials and rejections back to the front-end step or build rule that causes them.
- We work older accounts through to resolution, appeal or correction, so aging accounts receivable comes down.
- We show you where fixing eligibility, coding or authorization up front would stop the edit or denial before it happens.
Epic build and terminology vary by organization. Queue names, routing rules, and module configuration differ from one Epic instance to the next, so the specifics of how this work maps to your environment depend on your organization’s build.
FAQ
Frequently Asked Questions
Does A Billing Partner Replace Epic?
No. A billing partner works inside the Epic instance your organization already uses, logging into Resolute Professional Billing and working the same charge review, claim edit and follow-up queues your internal team does. It’s extra hands and billing expertise on the system you’ve already got.
What Is Resolute Professional Billing?
Resolute Professional Billing is Epic’s module for the professional (clinician-billed) side of the revenue cycle. It captures charges from clinical documentation, builds claims, runs them against edit rules, and routes accounts that need attention into work queues for billers to review and resolve.
Where Do Denials Show Up In Epic?
Denied, underpaid and unpaid accounts route into follow-up and denial work queues. That’s where your aging accounts receivable sits, and someone has to work, appeal, correct or rebill each account to recover the money. Exact queue names and routing depend on your organization’s build.
Why Does Front-End Work Matter With Epic?
Because Epic is heavily rule-driven, an eligibility, authorization or coding error at the front of the cycle shows up later as a claim edit or a denial. Get the front end right and claims don’t stop in queues in the first place. That beats working them after the fact.
What Would Fixing It Cost?
Ongoing Billing, Automation Programs and the Operations Partnership each have a published price and a written scope. Tell us what keeps going wrong, and we’ll point you to the right one.