CLAIMWISE BILLING
Behavioral Health Billing: Denials, Negotiations, and Appeals
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Let our 10+ years of proven experience conquering denials, negotiations, and appeals services for rehabs and other behavioral health providers benefit your practice.
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In an ideal world, insurance carriers would pay for correctly-filed claims with no questions asked. Unfortunately, as you might already know, this is often not the case. Enter: ClaimWise Billing Solutions.
Whether we're billing for individual therapy services or drug and alcohol addiction treatment center stays, we fight for maximum reimbursement. And we don't stop until you've been paid what you deserve.
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Take a closer look below.
Experienced behavioral health medical billers
It takes a lot of detective work and an experienced skillset to navigate payment denials and figure out how to resolve them. Many denials can be handled with a quick phone call and a short wait for a claim to reprocess. Others can sometimes only be solved with a lengthy appeal process.
Timeliness and persistence in following up is absolutely necessary to get these situations resolved, whatever their solution may be. Insurance companies put as many roadblocks as they can between providers and payment, and it’s necessary to stay on top of each and every claim to make sure that they pay without issue as quickly as possible.
Claim Submission Follow Up
The front end of the medical billing cycle begins when billers (AKA, us) submit claims for the services you've rendered at your drug and alcohol rehab or other behavioral health center. But on the back end, after we file your claims, there are a host of issues that can potentially arise. From medical record requests and carrier-specific preferences for coding, to something as simple as an inaccurate member ID, hold-ups happen in reimbursement endeveurs due to the complications of insurance carriers. Whether you're an in-network or out-of-network provider, ClaimWise knows what to do.
focus on your practice or rehab center
Denials, negotiations, and appeals are sometimes the most frustrating and time-consuming step of revenue cycle management for mental health providers. Rehab centers, individual therapists, and outpatient substance abuse treatment programs can save their precious time and resources by letting ClaimWise handle what we've been handling for over a decade. We're the mental health industry's best kept secret to maximum reimbursement, and we'll customize our entire RCM process to fit the needs of your practice or drug and alcohol rehabilitation center.
Third Party Pricers, Medical Coding, and Denials
Another form of insurance interference with reimbursement comes in the form of pricing. Claims can either be processed inside or outside of a network, and if processed out-of-network, carriers may employ a multitude of pricing methods. Some policies price using a percentage of medicare rates, while others use marketing data to establish a usual and customary rate.
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Policies that aim to save their members more on out-of-network claims often employ third-party pricers to negotiate a discount with the provider. These can come in the form of global pricing contracts, which can function like an in-network agreement, or claim-specific rate negotiations, which establish a negotiated rate on a claim-by-claim basis. As with every other step of the billing process, carriers often have their own way of going about pricing.
Again, whether billing services for treatment facilities or individual therapy sessions, there will always be denied claims. Indeed, thrifty insurance companies bank on providers not having adequate accounts receivable follow-up teams. Even if billing codes (HCPCS/CPT codes, revenue codes, diagnostic codes, etc.) are pristine, there will always be revenue left behind if billers don’t remain vigilant with their follow-ups. We're here to make sure you get exceptional payments for your services.
Interested in outsourcing your denials, negotiations, and appeals processes?
Let's get this show on the road. Fill out our quick and easy contact form below for more information. We'll get back to you within 24 hours.
