The full scope of the work.
For solo practitioners and small outpatient mental health practices. Virtual, nationwide, in whatever EHR and clearinghouse the practice already uses.
Claims & Revenue Cycle
Claim Submission & Scrubbing
Claims are generated by your EHR and submitted as they come. When one is scrubbed or rejected, I correct it and resubmit. What I add beyond that is pattern tracking: when scrubbing or rejection reasons repeat, that's a workflow gap, not bad luck — I bring it to you with documentation and a suggested fix, not just another resubmission.
Denial Resolution & Appeals
A denial is worked to a determination by someone who already knows this practice's payer mix and history — not a queue that starts from zero every time.
- Correct and refile where the defect is on the claim; request reconsideration — by portal or by phone with the payer — where the defect is in the adjudication.
- Document each step, with dates, reference numbers, and the representative or portal record behind it, so the appeal has a file behind it.
- Report the pattern to you. A denial reason that repeats needs a solution. Resubmitting without addressing the underlying cause is a costly administrative burden at best, and a potentially larger gap in revenue later.
Payment Posting & Correction
ERA payments post to the EHR automatically. I check those postings and correct the ones that land wrong, and manually post payments from EOP/EOB remittances that don't post on their own.
Eligibility & Pre-Intake Screening
Benefits, Eligibility & Network Verification
Coverage confirmed and documented before the first session. Many balance disputes months later trace back to a verification that was never documented or completed correctly.
- Active plan status and effective dates as of the date of service.
- Whether behavioral health is carved out to a separate administrator, and to which one.
- Network status confirmation.
- Deductible met to date, coinsurance or copay, and out-of-pocket status.
- Telehealth coverage and prior authorization requirements if applicable.
Pre-Intake Insurance Screening
A prospective client's insurance checked for out-of-network status before they're fully onboarded with a clinician, and self-pay rates communicated up front if that's the case. The financial conversation happens before treatment starts, not after a bill arrives.
Referral Management & Clinician Matching
Incoming referrals matched to the right clinician by population, specialty, modality, and availability.
Client Billing & Payments
Client Payments & Invoicing
Client invoices generated, and credit card payments run directly unless the client is set up for autopay — so a clinician isn't also running the front office.
Superbills
Generated for out-of-network and self-pay clients seeking reimbursement from their own insurance.
Billing-Related Client Communications
Benefit explanations, balance questions, and claim status handled directly with the client, by phone, email, or messaging, so a clinician is not opening a session with a collections conversation.
- Explaining what a plan actually covers, in terms a client can act on, before the balance becomes a dispute.
- Responding to statement and balance questions with the benefit coverage and claim record behind the number.
- Claim status updates while a denial or appeal is open, so the client is not calling the practice for them.
Provider & Payer Administration
Provider Portal Management
Payer and clearinghouse portals monitored and maintained: benefit and eligibility verification, claim status checks, EOB/ERA retrieval, and portal-based appeals and inquiries.
Provider Data & Credentialing Status Tracking
Application status and recredentialing deadlines tracked, provider directory attestations completed, and provider data errors traced down when they're the reason a claim denied or paid incorrectly. This is not credentialing or payer enrollment — when a new enrollment is the actual fix needed, that gets named and handed to the right resource.
Denial codes I work
Standard X12 claim adjustment reason codes. Each one has a different remedy, and the wrong remedy costs filing time you do not get back.
- PR-96
- Non-covered charge — payer policy exclusion
- CO-4
- Service not covered / not authorized
- CO-11
- Diagnosis inconsistent with procedure
- CO-16
- Claim lacks information needed for adjudication
- CO-18
- Duplicate claim
- CO-22
- Coordination of benefits
- CO-27
- Expenses incurred after coverage terminated
- CO-29
- Timely filing limit exceeded
- CO-97
- Payment included in allowance for another service
- CO-109
- Claim not covered by this payer / contractor
- CO-170
- Pre-certification or authorization not obtained
How we work together
- Ongoing Support
- I manage your practice's billing cycle on a weekly/hourly basis: eligibility, claims, denials, payment posting, communications and reporting handled as part of normal operations.
- Project-Based Engagements
- Defined-scope of work for a limited time period: clearing a denial backlog, auditing billing records for a specific period, or resolving a stalled provider-data issue. Scope and cost set before the work starts.
Not in scope
- Credentialing and payer enrollment
- Not part of what I take on directly. I track the deadlines and data around it, but I don't submit new enrollment applications or complete credentialing itself. If enrollment is the actual fix a claim needs, I'll name that and point to the right resource.
- Clinical documentation
- I do not read or write treatment plans or progress notes. What belongs in a clinical note, and whether a service was medically necessary, is the clinician's determination, not mine.
- Legal representation
- I am not an attorney. I will not respond to requests from or involving an attorney.
- Same-day turnaround and volume pricing
- The work is thorough and accurate. Time needed to set up and maintain best-practice billing workflows prevents much more costly downstream revenue loss.
- General scheduling and calendar management
- Clinicians or other staff manage basic scheduling and calendars. I don't take on front-desk scheduling duties or live phone support.
Rates
Contracts are negotiated by the number of estimated hours needed per week, with a minimum contract of 10 hours per week.
Rate is $40 per hour. You are only billed for the number of hours actually used above and beyond the 10-hour minimum.
Send your payer mix, monthly claim volume, and current accounts receivable aging, and I will send you an estimate on the number of hours per week I'd recommend for your contract. If what you need is outside what I take on, I will say so in the first reply rather than scope it into something it is not.