Mental Health Billing for Dummies

Mental health billing for dummies will teach you the billing terms you need to know, what information to collect, how to bill mental health insurance claims from start to finish, and what to do when it all messes up.

Mental health insurance billing is a pain!  We get it, it’s why we created a mental health insurance billing service after all.

mental health billing for dummies

But maybe you want to tackle this beast on your own; that’s brave.

We’re going to help you figure out the outline of mental health insurance billing.  There will be many links to other resources, scripts, and templates to help do mental health billing for dummies.

Mental Health Billing for Dummies Index

Helpful Mental Health Insurance Billing Terms

Mental Health Eligibility and benefits:

The past and present status of that client’s insurance policy through a particular insurance company’s coverage.

You call that company to inquire if they have active coverage, if you can see them based on your relationship with that insurance company, and if so, what their copay, deductible, or insurance looks like.

We do this for free, but here is a guide and script on how to do eligibility and benefits calls yourself.

mental health billing for dummiesCMS1500 Form:

This is the standardized form that insurance companies accept (although now less than before) for your claims submission.  Normally all of this information gets submitted digitally, rendering this form useless, unless you know exactly how to fill it out.

This form enables you to do advanced changes to your claims and billing.  Here is a sample CMS1500 form.

Claims Submission and Reprocessing:

The process by which you fill out a CMS1500 form with your client’s demographic and insurance information, your provider information, and the appointment information.

Timely Filing Window:

The allotted time today’s date of service from which you can file a claim.  For many companies it’s 90 days while some can be as long as 365 day timely filing window.

Corrected Claim:

A claim that uses previous billing information to make changes to future billing for that same service date.

Clearing House:

An online “filter” that ensures the claims you are submitting are formatted correctly.  Many insurance companies require providers to use an online clearinghouse.

Mental Health Billing for Dummies:  The Short Guide

  1. Make sure to collect all your client’s demographic and insurance card information.
  2. Check the eligibility and benefits of the client.
  3. Conduct a session if the client is eligible.
  4. Bill their insurance plan via their website or a CMS1500 form.
  5. Follow up with your claims to ensure it’s successful.
  6. Account for paid EOBs, refile denied claims.
  7. Charge client’s their allotted patient responsibility.

Many providers find managing their own billing to be outside of their job parameters.  If you want to spend less time doing your billing and more time working with clients, getting paid, then consider hiring our mental health insurance billing service.

Okay, you’re a masochist, let’s continue.

Chapter 1:  Gathering Information

You need to gather your provider information, the client’s demographic information, and the client’s insurance card information.

Here’s exactly what you need:

Gather Provider Information:

  • Provider Tax ID
    • either your E-IN (Employment Identification Number) or SSN (Social Security Number)
    • You will want to use what each panel has on file for your provider information
    • We find this out for you when we do our eligibility and benefits calls
  • Individual Provider NPI
  • Organizational Group NPI (If you have one)
    • You can lookup your NPI or an individual Type 1 NPI or organizational Type 2 NPI.
  • Provider License
  • Address
    • Use the address each insurance company has on file
    • Make sure to update your address with each insurance company when you change office locations
    • We do this for you with our service as well

Gather Client Demographic Information

  • Client Name as listed on their insurance card
  • Gender
  • Date of Birth
  • Address

Gather Client Insurance Information

aetna insurance card

  • Insurance Card Member or Subscriber ID
    • If they have a TriCare policy, collect both the number on the front and back of their card
  • Group number
  • Authorization number 
    • If obtained by the client OR it is required and you have obtained it from an eligibility and benefits call
  • Claims Address
  • Mental Health / Behavioral Health Provider Phone Number
    • The company might have one number for medical and one for mental health
    • The company might only one customer support phone number
    • You want to pick the number that talks about eligibility

Pro Tip:  Take a front and back photo of their insurance card with your smartphone and save it to a secure location.  You can refer to this later to ensure you have your information posting correctly.

Once you have gathered all of this information, save it in a secure location for future processing.

Now it’s time to verify their insurance coverage and your network status in their plan, then their benefits based on all of that, via a phone call.

Chapter 2:  Verifying Mental Health Benefits Information for Dummies

Call up the phone number on the back of their insurance card and begin the process of verifying eligibility and benefits.

Pro Tip:  when making your call, hit “0” or “#” a few times and see if you get forwarded to a representative.  If this doesn’t work on your first call, then use their normal call system.

Get Your Call Routed to the Right Eligibility and Benefits Line

Use the allotted information to get a quote for “outpatient mental health office visit services”.

This is your most likely mental health billing CPT code base to use, but if you are billing from a home location, assisted living facility, or via phone call, your billing will be different, and so will your eligibility and benefits request.

mental health insurance billing for dummies

Provide Demographic and Insurance Information

Give them the relevant information, most likely:

  • Client Name
  • Date of Birth
  • Member I.D. Number
  • Provider NPI
  • Provider Tax ID

Ask About Eligibility

Ask if this client has active coverage, including the effective date.  Write their response down.

mental health billing for dummiesAsk About Network Status

Ask the representative about your network status with this client’s plan.   Inquire about the type of plan and if you are in-network or out-of-network with their plan.

Save this information.

Ask How to Bill Claims Online

You want to understand how to bill claims online, digitally, because it’s the fastest way to submit claims and the easiest to track.  Medicare is requiring provider to move to all electronic claims.

If you use an EHR software like TheraThink’s EHR software, you’ll want to ask for the electronic Payer ID as well.  Write it down!!

IF YOU MUST bill claims via paper, ask about their claims address as well.  We always do for tracking purposed.

Request Information about Authorization or Limits

Ask if they have any limits to visits or authorization requirements.  Write down their responses.

They might require authorization to be requested, ask if you, as the clinician, can request authorization directly on your call.

When retroactive authorization can be awarded, do so and when not, fill out the necessary paperwork to request authorization.  (You guessed it, we take care of this for you).

Ask about Patient Responsibility for “Routine Mental Health Outpatient Visits in an Office Setting”

Gather if they have a copayment to make per session, or a deductible and coinsurance that you will need to bill them for after their sessions are billed to completion.

If they do have a deductible and coinsurance to pay, ask how much is remaining on their deductible.  Write it all down!

Pro Tip:  If they have a deductible and coinsurance, you are not supposed to collect anything up front!  This is a common misconception.

You are to charge them after the fact for their patient responsibility payment per session as listed on the completed EOB your receive from filing your claims.

Save all of this information in a file.

Now, go out there and actually perform what you got that masters degree for!:  providing services.

Again, if you’re tired reading about the ins and outs of insurance billing, you might save time, money, and headache delegating this part of your private practice.

Chapter 3:  Filing Claims

Filing claims involves submitting each date of service with all this information one by one.  Each insurance company has their own online portal to submit claims, some terrible, some fairly okay.

filing mental health insurance claimsDefinitive Guide to CPT Codes

If you don’t know which CPT codes to use for billing, refer to our popular and easy to read guide here.

File Claims via EHR

We recommend using one EHR software, ideally custom built only for mental health providers, to manage all your clients in one place, and to submit all your appointments through one website.

If you don’t want to use one centralized EHR system, you can file claims to each insurance company’s website via the submission guidelines in Chapter 2.

File Claims Site By Site

Go to Aetna.com or Cigna.com or MagellanProviders.com and login.

Use each platform to add the client’s you’re seeing to your account.

Submit appointment dates with the requisite CPT codes and diagnosis codes.

If you aren’t sure how to submit the claim accurately, consider asking a colleague or hiring an expert.

File Claims Via CMS1500 Paper Form

We recommend reading and using Barbara Griswald’s book Navigating the Insurance Maze as a primer on how to submit paper claims correctly.

This mental health insurance billing for dummies guide is just simply not the place to explain the vast number of ways that billing plays out.  We recommend seeking professional help online research, a colleague, course, or through delegation.

Truly, you do not want to file claims via paper if you can avoid it.

Use A Billing Service

If you don’t know which CPT codes to use, what diagnosis to use, the number of units to use, consider seeking professional expertise.

We help our providers by managing their data in an easy to use free EHR software, and communicating via calls, texts, and email.

For complex services like a 70 minute emergency call and then a two hour emergency session at their home, you might have absolutely no idea how to bill that situation.

You don’t have to when using a reputable mental health insurance billing service.

how to read mental health EOBsChapter 4:  EOB & Claims Processing

You’ve submitted your claims over to each respective insurance company for every date of service you rendered in the last month.  Congratulations!

Time to see if they all worked.

Follow Up On Insurance Claims Processing

Call the same company using the same eligibility and benefits number and ask for claims processing and EOB accounting.

Refer to your NPI and tax ID in their system, then ask if claims were received and have any errors.

You’ll want to do this for each date of service (DOS) that you have submitted to ensure they are processing.

Perhaps you submitted online, check your portal to see if claims are accounted for in your account.

Record “Claim Not On File” Claims

Save any dates of service that never made their way to the insurance company.  They will need to be refiled as soon as possible.

Also perform a new eligibility and benefits check for that client from Chapter 2 of this mental health billing for dummies guide.  Make sure you’re filing claims to the right place, with the right information.

Record Denials and Erroneous Claims

When claims are denied, ask why the claim is denied.  Normally these problems are easy to fix.  Someone’s last name was spelled wrong or they changed addresses or that “0” was actually an “O” (zero vs the upper cased letter ‘o’).

This part can be tedious because it means correcting and refiling claims, but it’s so important during this step in the process to gather the information that needs to be changed.

Be exhaustive with comparing what information you have on file and what they need.

Inquire about your own provider information as well.  What tax ID and NPI do they need you to file?

Determine the client’s demographic and insurance information.

Check if authorization was required and if so, can you obtain retroactive authorization for those mental health visits?

Claim ID or Claim Number for Corrected Claims

Ask for the claim ID for each date of service that you submitted.  You will need the claim ID or claim number for each date of service to refile your claims.

Other Options

We hunt for other ways to ensure claims are filed in a timely manner.  We call and ask for specific people to submit claims to, reps that can receive faxes on a call, or setup systems to ensure claims are successfully submitted and processed by each insurance company.

Use digital claims processing when possible for better tracking of your claims and data and faster claims submission.  Normally digital options to have a cost, for EHRs, so consider your options in choosing an online tool.

If you’d prefer to offload all of this nightmare, you can hire a billing service as well (and we only work with mental health providers).

refile corrected claimsChapter 5:  Refiling Claims, Appeals, Rejections

Go back to your EHR, online portal, or paper claims and refile these claims.

Submit As Corrected Claim

Make sure to submit the claim id number with all of the changes you need to make on your claims.

Submit the claim as corrected claims so they act to reprocess the original claim.

When To Just File Again

If the claim has not been received, no corrected claim needs to be submitted, the original claim needs to be submitted.  Ensure you refile claims in a prompt manner to make the timely filing window for claims submission.

Refile claims that have been received and rejected, you normally have a longer time to refile claims as corrected.  Even so, it is best to refile within 30 days if possible.

Redo the same form, website page, or appointment submission with the corrected information, file the claim as corrected via the appropriate method, and sent it on it’s way.

Re-File Insurance Claim As Corrected with a Billing Service

Happy to do this whole process for you as every other billing service should.

Re-File Insurance Claim As Corrected on CMS1500 Form

In box 22, use “7” for reprocessing the code.  Use “8” to void the initial claim completely.

Re-File Insurance Claim As Corrected on Other Online Platforms

EHR software and insurance company website is different and we have no general way to suggest how to do so — please see documentation for each.

Mental Health Billing for Dummies:  Just Get Billing Help

Seek a service that can do all of this for you.

Use your own EHR software and do most of it yourself.

Finally, you can completely give up and join an agency and close your private practice.

The majority of group practices and almost all successful individual private practices utilize outside billing services in one capacity or another.

Make an informed decision based on your needs.  If you want to spend as little time as possible, use a billing service.

If you have tons of time and need to save money, use an EHR system without a billing team and submit and follow up with claims on your own.

Mental Health Billing for Dummies: A Summary

Gather the right information.

Obtain eligibility and benefits and make sure you know how to submit claims and where.

Do the grunt work of typing all the information in.

Submit claims.

Follow up to make sure they were received and they’re processing.

File claims that are not-on-file, refile corrected claims.

Account for paid claims, charge clients.

Repeat.

Or hire a billing service, submit your weekly appointments in 10 minutes, and focus on your private practice.

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