Denial Management for Mental Health Practices

Why mental health claims are denied

Mental health claims are denied more often than most medical specialties, and the reasons are specific enough to list. Eligibility and benefit errors: the plan changed, the deductible reset, or the session limit was reached. Missing prior authorization for testing, for psychiatry services, or for sessions past a payer’s threshold. Medical necessity and documentation questions, usually on longer sessions. Timely filing, when a claim sat unworked past the payer’s window.

Then there is coding. Psychotherapy codes are time-based, so a 90837 billed on a note that supports 90834 is denied or downcoded. Add-on codes such as 90833 and 90785 are denied when the primary code or the documentation does not support them. Telehealth claims fail on modifier 95 and place of service 10 when a payer wants something different. Behavioral health carve-outs route the claim to a separate payer; a claim sent to the medical plan is denied unread. Coordination of benefits denials appear when a client has two plans and the payer order is wrong.

Prevention upstream

Denial management is mostly done before the claim is submitted. Insurance verification catches eligibility, carve-out, session-limit, and authorization problems at intake. Credentialing review during onboarding catches the lapsed panel that would deny every claim for a clinician. Claim scrubbing catches modifier, place-of-service, and code-pairing errors before the payer sees them.

That is why denial management is part of our full revenue cycle management and not a service sold on its own: the biller who verified the benefit is the one who sees the denial and can fix the cause, not just the claim.

Working denials within the week

Denials arrive on the ERA. We review denial codes as payments post, so a denial is corrected and resubmitted in the same weekly claim cycle. When the claim was correct and the payer was wrong, it goes to appeal with the session note, treatment plan, and the payer’s own policy attached. Timely filing and appeal deadlines are tracked per payer so nothing is lost to the calendar.

Aged A/R clean-up for new clients

Practices that come to us usually bring a backlog: claims a previous biller or a stretched front office never followed up. During onboarding we pull every open balance, group it by payer and reason, and work it in order of recoverable value and filing deadline. Some of it is recoverable with a corrected claim. Some needs an appeal. Some is past deadline and gets written off with a note so it stops inflating the aging report. Either way, the practice knows what happened to every dollar.

Tracking denial patterns

We track denial patterns across your payers and tell you what is causing them, as part of regular communication about how your accounts are performing. That is how a practice owner knows whether a problem is fixed or just moved. See metrics reporting for how we approach practice metrics, and our guides on why mental health claims get denied and how to appeal a denied therapy claim.

Who does the work, and where

All denial and appeal work is done by our own staff in Woodstock, Illinois, inside the EHR you already use, including TherapyNotes, Tebra (formerly Kareo), and SimplePractice. We serve practices nationwide, with the exception of New York and New Jersey. Request a consultation to start with your aging report.