How to Problem Solve Mental Health Insurance Claims

Welcome to our comprehensive guide on resolving mental health insurance problem claims.  In this article, we will provide a step-by-step approach to address common issues with mental health insurance claims. Whether you’re a private practitioner or considering hiring a billing service, we’ve got you covered.

We’ll explore the various challenges that can arise and offer solutions to ensure your claims are processed correctly. Let’s dive into the world of mental health insurance billing.

Identifying the Problem:

problem solve mental health insurance claims

Before you can resolve your mental health insurance problem claims, it’s crucial to identify the specific issues affecting your claims. These issues can occur at different stages of the billing process:

  1. Claims not processing through your EHR clearinghouse.
  2. Claims denied at the insurance company for various reasons.
  3. Missing information, such as modifiers, license, place of service, or taxonomy identifier.
  4. Errors in client’s insurance information, like incorrect names or subscriber IDs.
  5. Incorrect information with the insurance company, such as organizational NPI instead of individual NPI.

Problem Solve Mental Health Insurance Claims [Video]:

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How to Problem Solve Mental Health Insurance Claims PDF

The Clearinghouse’s Role:

Your EHR clearinghouse plays a pivotal role in ensuring that the information submitted to insurance companies is accurate and formatted correctly. It acts as a filter to prevent issues from arising at the insurance company’s end.

Common clearinghouse-related issues include correcting client information, practice details, and missing codes or modifiers.

Fixing Denials:

When dealing with denied claims, you’ll need to take specific steps to correct and resubmit them:

  1. Obtain the original claim ID.
  2. Update the claims data with corrected information.
  3. Refile the claims as corrected on a CMS 1500 form, specifying the resubmission code (‘7’) and the original claim ID.

Eligibility and Benefits Verification:

Preventing claim problems from the outset can be achieved by conducting eligibility and benefits verification calls. Ensure that you have the correct information, are in-network with the client’s plan, and have obtained any necessary authorizations. These verification calls can save you time and effort in the long run.

Benefits Payment Issues:

When addressing benefits payment issues, having a reference ID from an eligibility and benefits verification call can be invaluable. This information is essential when communicating with the insurance company to ensure your claims are reprocessed based on the original verification quote.


In summary, successfully resolving mental health problem claims involves proactive efforts and meticulous attention to detail. Here’s a step-by-step approach:

  1. Perform eligibility and benefits verification.
  2. Ensure your provider and practice information is accurate.
  3. Identify and correct claim problems.
  4. Follow up with insurance to ensure claims are processed and paid correctly.

Consider Hiring a Billing Service:

If dealing with mental health insurance claims seems overwhelming, you might consider hiring a billing service like TheraThink to handle these challenges for you. Billing services can provide the expertise and support needed to streamline the billing process and optimize your revenue.

We hope this guide has been helpful in navigating the world of mental health insurance problem claims. By following these steps and seeking assistance when necessary, you can minimize the headaches associated with insurance billing and focus on providing quality care to your clients.

For more information or to explore the services we offer, learn more about out mental health billing service. Thank you for reading, and best of luck with your mental health insurance claims!

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