Specialties / Behavioral Health Billing

Dedicated Behavioral Health
Billing Division

A division that does nothing else. Certified behavioral health coders, carve-out expertise, real-time telehealth modifier tracking, and a clear promise: your first-pass rate improves or you do not pay.

96%First-Pass Rate
32%Revenue Increase
50%Fewer Denials
10dFaster Collections

BH Billing Division Now Open

Built exclusively for behavioral health practices. We handle carve-out payers, telehealth modifiers, and the documentation standards that separate approved claims from rejected ones.

  • AAPC Certified BH Coders
  • Carve-out insurance expertise
  • Telehealth modifier 95 and GT
  • HIPAA plus OIG Compliant

Common Behavioral Health Billing Challenges

Behavioral health has the highest claim denial rate of any specialty.

Time-Based CPT Accuracy

Psychotherapy CPT codes require precise session-length documentation. Payers downcode claims without exact treatment minutes in the clinical record.

Impact: Revenue loss from systematic downcoding of 90837 to 90834 or 90832

Carve-Out Payer Complexity

Behavioral health benefits are carved out to separate insurance entities with entirely different billing rules, forms, and portals than medical claims.

Impact: Claims denied when submitted to wrong payer entity

HIPAA and 42 CFR Part 2

Mental health and substance use records carry heightened federal privacy protections requiring specific handling in billing documentation.

Impact: HIPAA violations and federal audit risk from improper disclosure

Credentialing Gaps

Therapists joining insurance panels face complex credentialing where one lapse can freeze billing eligibility for an entire clinician panel.

Impact: Revenue interruption during credentialing gaps or delays

Telehealth Modifier Complexity

Virtual behavioral health services require specific modifiers (95, GT), Place of Service codes (02, 10), and state-by-state telehealth law compliance.

Impact: Denials from incorrect POS codes or missing telehealth modifiers

Prior Authorization and Medical Necessity

IOP, PHP, and residential programs require prior authorization with clinical criteria documentation that differs from standard outpatient billing.

Impact: Treatment gaps and revenue loss from authorization denials

How We Solve BH Billing Challenges

Session-Time Accuracy

  • Exact minute documentation review per CPT code
  • Systematic 90837/90834/90832 code validation
  • Telehealth session-time tracking
  • Downcoding dispute and appeal support

Carve-Out Payer Management

  • Carve-out payer identification and routing
  • BH-specific claims scrubbing rules
  • Payer portal credentialing maintenance
  • EAP billing and reconciliation

Telehealth Compliance

  • State-by-state telehealth rule monitoring
  • Modifier 95 and GT application
  • POS 02 vs POS 10 determination
  • Originating site billing support

Credentialing and Panel Support

  • New provider credentialing applications
  • CAQH profile maintenance
  • Re-credentialing deadline tracking
  • Gap in coverage billing support

Ready to Improve Your BH Practice Revenue?

Our dedicated BH billing division delivers a 96% first-pass rate. Get your free audit today.