How to Verify Eligibility and Benefits for Mental Health Providers [with Scripts]

This short guide will teach you how to prevent mental health insurance claim denials from happening, why they happen most often, and the scripts to use to prevent rejected claims in the future.

Denied claims are the plague of mental health practitioners who take insurance.  “You did a great job in therapy.. but we’re not giving you a dime!”  It SUCKS!

Preventing denied claims is the number one time saver in personal billing and we can’t recommend that you spend the time to ensure you are filing correctly before you start filing enough.  It’s never, ever worthwhile to see a patient multiple times, wait on billing until the end of the month and file, only to realize they aren’t eligible for mental health benefits, they have an outstanding deductible, or you’re not in-network and they only reimburse in-network providers.

Even worse: they are completely covered but your practice and provider information doesn’t match the insurance company’s information.

Ouch.

We’re going to walk through how to never get denied mental health claims again.  This is a preventative tactic and cannot be used after filing!

We do this whole thing for you, front to back, with our billing service we provide exclusively to mental health providers.  If you’re interested, reach out!

Prevent Mental Health Denied Claims By…

Always verifying eligibility and benefits of your new patients over the phone!

It’s really that simple (don’t tell other billing companies we’re letting you in on the secret) and you only need to do it once per new patient.

If you call and confirm with an employee at their company that 1) you are in network, 2) your information is correct, and 3) the new patient is eligible for your mental health outpatient provider services, you will never deal with denied claims again.

Preparing To Check Eligibility and Benefits

You’ll need to prepare a bit of information before you begin, so go make sure you’ve gathered:

Provider information..

  • Your NPI number
  • Your Tax ID or Employment Identification Number (EIN) or Social Security Number (SSN)
  • Your License number (often not needed)
  • Your service address

Patient information..

  • Address
  • Date of Birth
  • Subscriber First & Last Name
  • Subscriber ID Number
  • Insured First and Last Name
  • Insured Relationship (self, child, spouse)

Ideally you have a front and back photocopy of the subscribers insurance card and if you don’t have one, in the future, always ask!  A simple photo from your smart phone will more than suffice.

 A Simple Eligibility and Benefits Phone Call Script

Time to get on the phone and call up your favorite insurance company to verify coverage for your new patient.

The following script will help you hit all the major points but also realize most insurance reps will guide you through this process on the phone naturally.  Make sure to ask some of these extra questions as well to cover all your bases.

  1. “I’m looking to verify eligibility and benefits for a new patient for Outpatient Mental Health Provider services”
  2. “Before I begin, I want to make sure I am an in-network provider for your panel, can you please check?”
  3. “Great, and I want to verify you have the correct address for my office, it’s _________”
  4. “The subscriber ID, date of birth, and first and last name are..”
  5. “I want to confirm there are no limits or authorizations required for this patient”
  6. “I wanted to confirm the following CPT codes: 90791, 90834, 90837, 90847” (add any  other CPT codes you bill for here)
  7. “What’s the copayment or coinsurance for this patient?”
  8. “Does this patient have an outstanding deductible?”
  9. “What address should I send my claims to?”
  10. “What is the Payer ID for electronic claims?”
  11. “Thank you so much for your help, can you please provide me your name and a reference ID for this call for my records?”

Viola!  You have all the necessary information to ensure your claims will be filed successfully, where to file them, and if anything does go wrong, how to reference the call to ensure your claim will be corrected.

Make sure to write down answers to all of these questions as they will be crucial for your notes as well as for charging your new patient’s copayment in office.

Hate the idea of doing this every time a new client wants to work with you?  We can do all of this (and way more) for you if you want.  Reach out about how we can help your practice with our billing service!

The Secret to Skipping the Insurance Prompts

When you call insurance companies, make sure you are calling the provider hotline, and then you’ll want to get through to the prompt that asking about eligibility and benefits.

At this point, it’s  your job to simply wait on the phone and not enter anything in.  After waiting 5 seconds after no words or voice come from the other side, start saying any and all of these words into the phone!

  • representative
  • agent
  • operator
  • customer service
  • customer support

Also try pressing the “0” (zero) button on your phone’s keypad.

(True secret, outsource it).

Filing & Checking Up

So you’ve seen your new patient and it’s time to file your claims.  Go ahead and make sure you reference your notes from your eligibility call to ensure you’re using all the right address and subscriber information.  Send them off!

Depending on if you file electronically or via paper, you’ll want to call the insurance company to confirm they’ve received your claim and are processing it successfully.  You only need to do this once as well but it can help stop future headaches so it’s recommended.  (While on the phone you can ask about multiple new patients).  For electronic claims, wait for two business weeks, and for paper claims, wait for three to three and a half weeks.

Conclusion

Most denied claims happen because the patient wasn’t eligible for your services.  Second most common: your information doesn’t match the insurance company’s information.  Call to verify both and use the tips in this article to do it quickly!

FAQ

Do I really have to call every time?

Yes!  If you don’t want to, consider hiring a billing company!

What’s the best time to call?

First thing in the morning!  Don’t call at lunch.

Why collect a reference ID for the call?

This keeps the insurance company accountable for their own human error and enables you to successfully fight any error that might occur.

Can’t I just check online?

You can but often times the information isn’t detailed enough and can be very challenging to understand.  We strongly recommend you call.

How long does it normally take to call?

If you call in the morning and use our tips, you should be off the phone within 15 minutes.  If you consider the life-time value of a new patient and the cost of not making this call, it’s a small price to pay to ensure you’re filing correctly and not dealing with the headache that is denied claims in the future.

But really, do I have to??

YES!  And be courteous when you call to ensure you get the best answers, more quickly.

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