Billing and Claims Management
What We can do for you
Simplify Billing, Accelerate Claims, and Focus on Patient Care
Accurate Coding
We provide accurate coding services to help ensure your claims are approved quickly and efficiently without errors.
Claims Submissions
Our billing and claims team is highly experienced and 100% reliable in sending out clean, error-free claims for faster processing.
Tracking Claims & Payment Posting
We offer complete tracking services for claims and payment posting, managing every single step of the billing process seamlessly.
Verification of Benefits (VOB)
Our team performs double verification of benefits (VOBs) to ensure accuracy and minimize any potential issues or delays.
Utilization Review
We conduct utilization reviews to ensure that patients receive the appropriate level of care they need based on their unique circumstances.
Challenging Payments Below UCR Thresholds
Our experts assist in challenging payments that fall below UCR thresholds, ensuring you do not miss out on potential revenue opportunities.
Weekly Reports
We provide detailed weekly reports so that you always know where you stand financially, making it easier to make informed decisions.
Quality Assurance & Appeals
Our quality assurance team collaborates closely with the appeals department to ensure that your medical necessity documentation meets all requirements for compliance.
Why choose us as your revenue cycle partner
Maximize Your Revenue with Proven Payment Challenges
Boost your revenue by challenging payments below UCR (Usual, Customary, and Reasonable) standards. We leverage industry-proven techniques to compare claim offers against similar services within your area. When discrepancies are found, we immediately contest low payments, often securing offers 30% higher.
Don’t leave money on the table—ensure accurate documentation and maximize your resources for better patient care.
Proven Billing & Claims Expertise
With a deep understanding of billing intricacies, our team efficiently manages claims and maximizes reimbursements. Our proven strategies ensure seamless revenue management, helping you avoid errors and delays.
Dedicated Revenue Optimization
Our goal is to optimize your revenue by addressing underpayments, enhancing claims accuracy, and providing thorough follow-up support. We work alongside you to achieve the financial success your healthcare practice deserves.
Behavioral Health Billing Services: Frequently Asked Questions
In behavioral health, the three core billing types are professional billing (clinician services), institutional billing (facility-based care like residential or PHP), and hybrid billing (combined professional and facility claims). Most behavioral health clinics handle institutional or hybrid billing, which requires specific CPT and revenue codes per level of care.
In behavioral health billing, the top five denial reasons are lack of medical necessity, missing or expired prior authorization, incorrect level of care coding, documentation gaps in the treatment record, and parity violations under MHPAEA. Each requires a different appeals approach to recover revenue.
Denial code 4 means the procedure code is inconsistent with the modifier used or a required modifier is missing. In behavioral health, this often appears with CPT 90837, 90834, and group therapy codes when telehealth, location, or service-intensity modifiers are applied incorrectly.
The nine steps are patient registration, insurance verification, charge capture, coding, claim submission, payment posting, denial management, appeals, and reporting. CodeMax handles every step inside one platform, including utilization review and challenging payments below UCR thresholds.
Five common behavioral health CPT codes are 90791 (psychiatric diagnostic evaluation), 90834 (45-minute psychotherapy), 90837 (60-minute psychotherapy), 90853 (group psychotherapy), and H0015 (intensive outpatient program). Accurate coding across these codes drives faster reimbursement and fewer denials.
