Behavioral Health Revenue Cycle
Mental Health Billing Services For Psychiatry, PMHNP & Psychology Practices
Unpaid claims, repeat denials, and billing questions should not keep landing on the practice owner. We provide mental health billing services for psychiatry, PMHNP, psychology, and therapy practices, with clear responsibility for claim submission, payment posting, payer follow up, and reporting.
Ask Practice Concierge See PricingStart With The Billing Problem You Need Solved
A growing balance does not always mean the billing team needs to send more claims. The problem may be missing charges, a provider not linked to the practice, rejected files, unpaid claims with no recent follow up, or payments posted to the wrong account. We trace the problem before deciding what to change.
- Claims are not reaching the payer: review the submission, rejection message, provider records, and correction process.
- The same denial keeps returning: identify the payer rule or workflow error, correct the affected work, and show staff how to prevent a repeat.
- Payments do not match the reports: compare remittances, posted payments, adjustments, and deposits before relying on the totals.
- The owner cannot tell what is happening: report what moved, what is still unpaid, who is working it, and when the next action is due.
Ongoing Core RCM is for recurring billing work. A Revenue Cycle Stabilization Sprint addresses a defined set of problems. Credentialing, eligibility checks, and prior authorization are separate unless the written scope includes them. The right choice depends on the work your practice needs, not the size of a software dashboard.
Credentialing is calculated from the selected provider and payer paths in the pricing builder. Core RCM is 7% of collections, with a $500 monthly minimum per provider. It includes claim scrubbing and submission, rejection and denial follow-up, payment posting and adjustments, A/R follow-up, reconciliation, and reporting. Eligibility and benefits verification and prior authorization require a separate written scope.
What We Manage
Billing Support From Eligibility Through Payment
Claim submission is the last step, most revenue leaks start upstream.
Clean Claim Flow
Claims that go out complete, correctly coded, and on time.
Find And Fix Denial Causes
Patterns tracked by payer, code, and provider, not just resubmitted.
Eligibility And Benefits By Written Scope
Coverage and rider verification can be added when it is listed in the signed scope.
Prior Authorization By Written Scope
Authorization requests and expiration tracking can be added when they are listed in the signed scope.
Payer & Policy Monitoring
Auth rules, fee schedules, and telehealth changes flagged for your mix.
Posting & Reconciliation
Payments and adjustments recorded so your AR report reflects reality.
Revenue Visibility
Know What Is Billed, Denied, And Paid
One dashboard shows what is billed, collected, denied, and sitting in AR, by provider and payer. It is the information you need for staffing, scheduling, and payer-mix decisions, part of full revenue cycle management.
Ask Practice ConciergeHow It Works
Three Steps To A Steadier Revenue Cycle
Review
We map your denial rate, aging AR, payer mix, and where claims are stalling.
Fix At The Source
We correct the upstream intake, coding, or credentialing gap driving the pattern.
Keep Claims And Follow Up Moving
Clean claims go out, denials get worked, and you get monthly visibility.
Who We Bill For
Built For Mental And Behavioral Health Practices.
Psychiatry
E/M, psychotherapy add-ons, and prior-auth-heavy payer rules.PMHNPs & NPs
Medication management, add-ons, telehealth, and supervision billing.
Psychology & Testing
Time-based therapy plus psychological testing and assessment codes.
Group Practices
Multi-provider consistency and panel-wide revenue visibility.
Where Billing Connects
A Recurring Denial Usually Starts Upstream.
FAQ
What We Do
Where Behavioral Health Claims Actually Fail
Most recurring denials in behavioral health start before the claim is ever built.
Denials Usually Start At Intake
Wrong plan selected, behavioral health carved out to a separate vendor, or an expired authorization. By the time it denies, the visit is weeks old and the fix is retroactive.
Code Selection Has To Match The Note
Session length, add-on codes, and the distinction between an evaluation and ongoing therapy all have to agree with what the documentation supports. Payers audit that pairing.
Telehealth Rules Vary By Payer
Place of service and modifier expectations differ between plans and change between years. A setup that paid last year can deny this year without anything else changing.
The Weekly Review Is The Control
Denials get grouped by cause and owner, worked on a cadence, and checked against the same definitions each week so a moving total means something.
Mental Health Billing FAQs
What CPT Codes Do Behavioral Health Practices Bill Most?
Common codes include 90791/90792 for evaluations, 90832/90834/90837 for individual psychotherapy, 90853 for group, the add-on codes 90833/90836/90838 with an E/M visit, and 99213/99214 for medication management. The right code depends on the service and what the documentation supports.
Why Do Behavioral Health Claims Get Denied More Often?
Prior-authorization rules, time-based coding, session limits, telehealth modifiers, and credentialing gaps all add denial risk. Most are preventable with a clean front-end process and disciplined denial follow-up.
Do You Bill Telehealth Sessions?
Yes. We use the correct modifier (95 for audio-video, 93 for audio-only) and place-of-service (02 or 10), and keep the rules current as payers change them.
Can You Work With Our Existing EHR?
Yes. We work inside SimplePractice, TherapyNotes, Valant, Kareo/Tebra, AdvancedMD, and others rather than forcing a switch.
Practice Systems · Improve The Systems Your Practice Already Uses
Revenue Cycle Work Queues That Show The Next Action
The team can separate payer responses from correctable practice issues, work the next action, and see aging and repeat causes.
What AdvanceAPractice Changes Or Builds
- Trace representative eligibility, claim, remittance, posting, and follow-up records.
- Configure cause categories, assignments, deadlines, reports, and management checks.
- Document whether the next correction belongs to practice staff, the biller, the system administrator, or the payer.
What Your Team Receives
- Denial and payment resolution tracker
- Cause and next action categories
- Aging and repeat issue report
- Weekly review and escalation instructions
Systems We Configure
- Valant, Tebra/Kareo, Office Ally, AdvancedMD, and other outpatient billing systems
- Availity and insurance portals for claim status, eligibility, authorizations, and payment details
- Office Ally, Change Healthcare/Optum, Waystar, TriZetto, and Claim.MD clearinghouse reports
- Excel, Google Sheets, SharePoint, and the Command Suite for A/R worklists and owner reporting
Systems We Assess For This Work
- The practice’s clearinghouse and insurance portals for the transaction and payer in scope
- Valant, Tebra, or another EHR report for charge, claim, payment, or aging detail
- Electronic claim, eligibility, claim status, and remittance files when the supported workflow requires them
Implementation Methods
- Native reports and work queues
- Clearinghouse exports and electronic remittance files
- Controlled reconciliation when no supported automated path exists
Access Needed
We need authorized EHR, clearinghouse, and payer access, representative transactions, the current billing workflow, and an owner who can approve corrections.
Running a higher level of care? The rules change: see IOP vs PHP billing.