Authorization runs out mid-episode
IOP and PHP authorizations from Michigan Medicaid PIHPs and commercial plans expire on a session count, not a date. Nobody watches the counter, so the last two weeks of treatment get written off.
Mental health billing built for Michigan practices
We bill the codes other billers get wrong for Michigan practices .
Psychiatry, therapy, PHP, IOP and residential programs across Michigan lose revenue to prior-auth gaps, downcoded 90837, and telehealth modifier errors. We live inside Michigan's payer mix BCBSM, Blue Care Network, Priority Health, HAP, Meridian and Molina so we catch those errors before submission, not after the remit.
✓ No setup fee ✓ 30-day rolling contract ✓ US-based certified coders
| CPT | Payer | Finding | Status |
|---|---|---|---|
| 90837 | BCBS | 52 min documented | Clean |
| 90834‑95 | Aetna | POS 10 missing | Fixed |
| H0015 | UHC | Auth expired day 12 | Held |
| 99214+90833 | Medicare | E/M split valid | Clean |
2 corrected before submission0 rework
Where the money goes
Four denials that drain Michigan behavioral health practices
General medical billers treat mental health as an afterthought. These four account for most of the recoverable revenue we find in a Michigan practice's first-month audit.
Your 60-minute sessions get paid as 45
Payers downcode when start and stop times aren't in the note. We flag the documentation gap before the claim leaves, not after the remit arrives.
Telehealth billed to the wrong place of service
POS 02 versus 10, modifier 95 versus GT the rules differ across BCBSM, Priority Health and Michigan Medicaid, and they change yearly. One wrong pair denies the whole batch.
Denials sit in a queue nobody owns
A denial is a task, not a verdict. When appeals aren't worked on a schedule, claims quietly age past the Michigan filing window and become unrecoverable.
How we work a claim
Seven checkpoints, in order, every time
Each stage has an owner and a deadline. If a claim stalls, you see it in your weekly report before the payer clock runs out.
- 01
Eligibility
Benefits, deductible, session limits and auth requirements verified before the visit, including Healthy Michigan Plan and PIHP/CMHSP coverage.
- 02
Authorization
Units tracked against the approved count, with renewal filed ahead of expiry.
- 03
Coding
CPT and ICD-10 assigned by AAPC-certified coders against the clinical note.
- 04
Charge entry
Encounters reconciled to your schedule so no session goes unbilled.
- 05
Scrub & submit
Michigan payer-specific edits run pre-submission. Errors get fixed, not appealed.
- 06
Posting
ERA and EOB posted line by line, with underpayments flagged against your contracted rate.
Denied → appeal in 48 hrs
- 07
A/R follow-up
Every claim over 30 days worked weekly until paid, appealed or written off with a reason.
Services
Take the whole cycle, or just the part that's broken
Most Michigan practices start with denial management and A/R cleanup, then move the full cycle over once the backlog clears.
Insurance eligibility verification
Active coverage, deductible, co-pay, session caps and prior-auth requirements confirmed before the patient is seen so nothing is billed into a dead policy or the wrong Michigan Medicaid plan.
See how it works →Mental health medical coding
AAPC-certified coders assign CPT and ICD-10 against the note, including E/M plus psychotherapy add-ons, testing, and crisis codes with an audit trail.
See how it works →Charge entry
Encounters reconciled daily against your schedule. Missing documentation is flagged to the clinician before it becomes an unbillable session.
See how it works →Claim submission
Payer-specific scrubbing before the claim leaves the clearinghouse, with rejections corrected same-day rather than waiting on a remit.
See how it works →Payment posting
ERAs posted line by line and reconciled to your contracted rates, so BCBSM and Priority Health underpayments surface instead of quietly closing the balance.
See how it works →Denial management & appeals
Every denial categorised by root cause, appealed within 48 hours, and fed back into the scrub rules so the same denial doesn't repeat next month.
See how it works →A/R follow-up
Aged claims worked on a weekly cadence by bucket, with an outcome recorded for every claim paid, appealed, or written off with a documented reason.
See how it works →Patient billing & statements
Clear statements and a support line your patients can actually call handled with the discretion behavioral health billing requires.
See how it works →Full revenue cycle management
All eight functions above under one team, one report, and one point of contact who knows your Michigan payer mix by name.
See how it works →Specialties
Built around your level of care
A solo therapist in Ann Arbor and a 40-bed residential program in Grand Rapids have almost nothing in common at the claim level. We bill both, differently.
Results
What changed for three real practices
Measured against each practice's own baseline in the 90 days before onboarding.
%98
Reduction in first-pass denial rate
Root cause was telehealth POS/modifier mismatch across BCBSM and Priority Health. Fixed at the scrub layer in week three.
$90K
Recovered from aged A/R
Backlog of claims aged 90–180 days worked to resolution before the timely filing window closed.
30 days
Reduction in days in A/R
Authorization unit tracking against the PIHP approval stopped mid-episode write-offs and shortened the payment cycle.
Security & compliance
PHI handling you can put in front of an auditor
Behavioral health records carry extra protection under 42 CFR Part 2. Our controls are built for that, not retrofitted.
- ✓Signed BAA before any accessExecuted with every client and every subcontractor.
- ✓42 CFR Part 2 aware workflowsSubstance use records segregated and disclosed only with valid consent.
- ✓Encryption in transit and at restTLS 1.2+, encrypted storage, no PHI over personal email.
- ✓Role-based access & audit logsMinimum-necessary access, reviewed quarterly.
- ✓Annual HIPAA trainingDocumented for every staff member, records available on request.
- ✓Breach notification policyWritten procedure, tested, provided at onboarding.
Pricing
Percentage of collections
We're paid when you're paid. No per-claim fees, no charge on claims we don't collect.
2–4% of monthly collections
Rate depends on claim volume, payer mix and level of care.
- ✓No setup or implementation fee
- ✓30-day rolling agreementLeave with 30 days' notice. Your data comes with you.
- ✓Named account leadSame person every week, reachable by phone.
- ✓Weekly reporting includedDenials by root cause, A/R by bucket, collection rate.
Questions
What Michigan practices ask before switching
How much do mental health billing services cost in Michigan?
Most behavioral health billing companies charge a percentage of collections, typically 2%–4%. The rate depends on claim volume, payer mix, and level of care residential and IOP billing is more labour-intensive than outpatient therapy. We quote a fixed percentage after reviewing your last 90 days of claims, and we don't bill on claims we fail to collect.
Do I have to change my EHR or practice management system?
No. We work inside the system you already use SimplePractice, TherapyNotes, Valant, Tebra, AdvancedMD, athenahealth and others. You grant us role-based access under a signed BAA. There's no data migration and no new software for your clinicians to learn.
Do you handle Michigan Medicaid and the PIHP/CMHSP carve-out?
Yes. We verify whether a service falls under the member's Medicaid Health Plan or the specialty behavioral health carve-out administered by the regional PIHP and its CMHSP, bill each to the correct payer, and track the session-count authorizations these programs use.
How long does it take to see a change in collections?
Clean-claim improvements show up in the first payment cycle, usually 2–4 weeks. Recovery from aged A/R takes longer, because appeals move at the payer's pace expect 60–120 days for the bulk of a backlog. Any claim already past the timely filing window is generally unrecoverable.
Why does mental health billing need a Michigan specialist?
Behavioral health has rules general medical billing doesn't: time-based psychotherapy codes that get downcoded without documented start and stop times, session-count authorizations for IOP and PHP, per-diem codes for residential care, telehealth place-of-service rules that differ by payer, and 42 CFR Part 2 restrictions on substance use records. On top of that, Michigan's Medicaid carve-out and dominant BCBSM footprint have local quirks a national biller usually hasn't seen.
Is my patient data secure?
We sign a Business Associate Agreement before accessing any system. PHI is encrypted in transit and at rest, access is role-based and logged, staff complete documented annual HIPAA training, and we maintain a written breach notification procedure that we provide at onboarding.
What happens if I want to leave?
Thirty days' written notice, no exit fee. Your data lives in your own EHR and clearinghouse throughout, so there's nothing to extract from us. We work outstanding claims through the notice period and hand over an open-items list.
Do you bill Medicare and Medicaid for behavioral health?
Yes. Medicare covers services from psychiatrists, clinical psychologists, clinical social workers, and since 2024 enrolled marriage and family therapists and mental health counselors. Michigan Medicaid rules are set statewide and split across health plans and the specialty carve-out; we confirm the exact plan, covered codes and auth rules for your patients during the audit.
