Mental & Behavioral Health revenue cycle management
Authorization-heavy, session-based billing done right - expired auths and exceeded units are the top leaks. AI agents renew authorizations before units run out and run the recurring cycle end to end.
Behavioral health lives and dies on authorizations and recurring session billing. Missed auths, exceeded units and telehealth modifier errors are the top revenue leaks. AI agents renew auths before units run out, bill telehealth correctly, scrub recurring claims, and work denials and collections.
Prior authorization & units
- Auth request & renewal - Assembles medical-necessity documentation and submits or renews authorizations before units run out.
- Unit & visit tracking - Tracks authorized vs. used sessions and alerts before expiry.
- Concurrent / continued-stay review - Prepares continued-stay documentation for IOP/PHP levels of care.
- Auth-expiry alerts - Warns clinicians before an authorization lapses mid-treatment.
Coding & claims
- Session coding & modifiers - Validates time-based CPT (90837 vs. 90834), telehealth POS/modifiers (95, GT) and add-on codes.
- Add-on & crisis-code capture - Captures interactive-complexity and crisis codes when documented.
- Recurring claim scrubbing - Scrubs and submits recurring session claims automatically.
- Time / documentation match check - Confirms documented time supports the code billed.
Eligibility & benefits
- Behavioral-health eligibility - Verifies coverage, copays and visit limits - often carved out to a separate payer.
- Carve-out & secondary detection - Detects behavioral carve-outs and secondary coverage.
- EAP session verification - Confirms EAP session authorizations and remaining visits.
Claims & submission
- Claim submission & edits - Submits claims through the clearinghouse with payer edits applied.
- Claim status follow-up - Polls 276/277 status and chases stuck claims.
Payments, denials & AR
- ERA auto-posting - Posts remittances and adjustments automatically.
- Auth & modifier denial recovery - Auto-appeals the recurring denials: no auth, exceeded units, wrong modifier.
- AR worklist prioritization - Prioritizes AR by recoverable value and timely-filing risk.
Patient collections
- Superbill generation - Generates out-of-network superbills for patient reimbursement.
- Sliding-scale & payment plans - Runs sliding-scale billing, statements and payment plans.
Intake & scheduling
- Recurring appointment & no-show management - Holds recurring slots, reminds patients and backfills cancellations.
- Intake call answering & booking - Answers inbound, screens and books into the EHR (SimplePractice, TherapyNotes, Kareo).
- Digital intake & consent forms - Collects intake, consent and insurance details before the first session.
Analytics
- Utilization & no-show dashboards - Tracks authorization utilization and no-show patterns.
What you get
- Never lose revenue to an expired authorization again
- Track authorized vs. used units in real time
- Bill telehealth sessions with the correct POS and modifiers
- Automate recurring session claims
- Verify carved-out behavioral benefits before intake
- Recover auth- and modifier-driven denials
Frequently asked questions
How do behavioral health authorizations work?
Most plans authorize a fixed number of sessions or units over a period, and require concurrent or continued-stay review to extend them. Sessions delivered after the units are exhausted or the authorization has expired are denied, and are usually not appealable.
How is telehealth billed for behavioral health?
Telehealth sessions require the correct place-of-service code and, for many payers, modifier 95 or an equivalent. Payer rules differ and have changed frequently, so applying the wrong combination is a leading cause of behavioral-health denials.
How do you bill therapy session length?
Psychotherapy is time-based, with distinct codes for approximately 30, 45 and 60 minute sessions. The documented time must support the code billed, which makes accurate session documentation a direct revenue and compliance issue.
What is the biggest revenue leak in behavioral health?
Authorizations lapsing mid-treatment. Because care is recurring, an expired authorization can silently affect weeks of sessions before anyone notices. MedXFlow tracks units and expiry dates and renews authorizations before they run out.