Substance Abuse & Addiction Billing
SUD treatment billing (ASAM 1.0 to 3.7) · Residential and detox billing · PHP and IOP billing codes and rules · MAT/MOUD billing (buprenorphine, naltrexone) · Co-occurring disorder billing compliance
Billing.
Behavioral health billing is more complex than general medical billing. Authorization requirements, level-of-care documentation, payer-specific coding rules, and carve-out structures create denial patterns that standard billing systems are not built to handle. We build billing infrastructure that is.
Schedule a Consultation →- SUD treatment billing (ASAM 1.0 to 3.7)
- Residential and detox billing
- PHP and IOP billing codes and rules
- MAT/MOUD billing (buprenorphine, naltrexone)
- Co-occurring disorder billing compliance
- Outpatient mental health billing
- Psychiatric evaluation and E&M coding
- Psychotherapy add-on codes (90833, 90836, 90838)
- Medication management billing
- Telehealth billing compliance
- Insurance eligibility verification
- Benefits investigation and VOB
- Prior authorization workflow design
- Authorization tracking and renewal
- Patient financial responsibility communication
- Behavioral health CPT and HCPCS coding
- Claim scrubbing before submission
- Payer-specific formatting compliance
- Timely filing management
- Electronic and paper claim submission
- Denial root cause analysis by payer
- Appeal workflow development
- Clinical appeal preparation
- A/R aging and recovery
- Underpayment identification and recovery
- Clean claim rate monitoring
- Days in A/R and collection rate reporting
- Denial rate tracking by payer and code
- HIPAA billing compliance
- Payer contract compliance review
What We Do
Billing Infrastructure Built for Behavioral Health
Mental Health & Psychiatry Billing
Outpatient mental health billing · Psychiatric evaluation and E&M coding · Psychotherapy add-on codes (90833, 90836, 90838) · Medication management billing · Telehealth billing compliance
Front-End Revenue Cycle
Insurance eligibility verification · Benefits investigation and VOB · Prior authorization workflow design · Authorization tracking and renewal · Patient financial responsibility communication
Behavioral Health Billing
A behavioral health organization's billing system either captures the revenue its clinical work earns, or quietly erodes it.
Claims & Clean Claim Optimization
Behavioral health CPT and HCPCS coding · Claim scrubbing before submission · Payer-specific formatting compliance · Timely filing management · Electronic and paper claim submission
Denial Management & Collections
Denial root cause analysis by payer · Appeal workflow development · Clinical appeal preparation · A/R aging and recovery · Underpayment identification and recovery
Reporting & Compliance
Clean claim rate monitoring · Days in A/R and collection rate reporting · Denial rate tracking by payer and code · HIPAA billing compliance · Payer contract compliance review
Who This Is For
Programs With Billing Problems That Have Become Revenue Problems
Most of our billing clients have the same presenting problem: denial rates are high, collections are below what the clinical volume should produce, or days in A/R keeps climbing without a clear explanation. The root causes vary, but they almost always trace back to the front-end: authorization problems, benefit verification gaps, or documentation that does not support the level of care being billed.
For context on where behavioral health billing commonly breaks down, read our guide to behavioral health prior authorization and our overview of common MAT billing mistakes and OTP claim denials.
Common Failure Points
Where Behavioral Health Billing Breaks Down
- Authorizations expire mid-stay without concurrent review, generating a backlog of unbillable services
- Benefit verification done at admission but not updated when coverage changes, leading to denials that are months old before anyone catches them
- Clinical documentation that does not support the level of care being billed, resulting in downcoded claims or medical necessity denials
- No denial analysis by root cause, so the same denials recur month after month without a fix
- A/R aged past timely filing limits because there was no system to track and appeal denials before they lapsed
Frequently asked questions
What is a clean claim rate and why does it matter?
A clean claim rate is the percentage of claims that pass through without requiring correction, resubmission, or follow-up. A high clean claim rate means faster payment and less staff time chasing denials. Behavioral health billing has lower clean claim rates than most specialties because of the complexity of authorization requirements, level-of-care documentation, and payer-specific coding rules. Improving this rate is usually the fastest way to reduce days in A/R and increase collections without adding census.
How do prior authorizations affect behavioral health billing?
Authorizations are one of the most common points of failure in behavioral health revenue cycle. Expired authorizations, level-of-care changes without re-authorization, and concurrent review denials all generate claims that cannot be collected. The front-end of the billing process, benefit verification, authorization management, and concurrent review tracking, determines how much of the clinical work can actually be billed. Our guide to behavioral health prior authorization covers this in detail.
What makes MAT billing different from standard SUD billing?
MAT billing involves multiple claim types that interact in complex ways: the office visit, the medication itself (if dispensed in-office), and in some cases the monitoring services. Buprenorphine, methadone, and naltrexone each have different billing rules depending on the setting and the payer. Carve-outs, formulary restrictions, and prior authorization requirements vary significantly across commercial payers and Oregon Health Plan managed care plans. MAT billing errors are a common source of both denials and compliance risk.
How long does it take to improve denial rates after implementing new billing processes?
Denial patterns from process changes take 60 to 90 days to show in the data, because claims already in the pipeline were submitted under the old process. Root cause analysis on current denials is the starting point, it tells you whether the problem is front-end (authorization, eligibility), coding, or documentation. Most organizations see measurable improvement in denial rates within a billing cycle after the root causes are addressed. Recovery of aged A/R can take longer depending on payer timely filing limits.