Denials you never see coming
Session-limit rejections, missing modifiers and payer-specific rules quietly erode collections month after month.
Revenue cycle management (RCM) built for behavioral health practices
Faster reimbursements, fewer denials and far less administrative weight — so you can stay focused on patient care instead of insurance paperwork.
- No long-term contracts
- HIPAA-compliant processes
- Dedicated account manager
Sound familiar?
Behavioral health billing breaks generic RCM
Session-based codes, carve-outs and parity rules don't behave like the rest of healthcare. Here's what we hear most from practice owners.
Prior auth maze
Units, re-auths and concurrent reviews for IOP, testing and med management eat hours of clinical time each week.
Under-paid sessions
Parity violations and stale fee schedules mean 90837 gets paid like 90834 — and nobody catches it.
Billing staff turnover
When your one biller leaves, institutional knowledge and a full A/R queue walk out the door with them.
Telehealth compliance drift
POS 02 vs 10, modifier 95 vs GT, state-by-state rules — the goalposts move every plan year.
Wrong payer, wasted claim
The medical plan says Aetna. The behavioral health benefit is actually carved out to a separate administrator entirely. Generic RCM tools don't know to check — so claims get submitted to the wrong place before anyone catches it.
Services
Your full revenue cycle, handled end to end
Take the pieces you need or hand us the whole cycle. Either way, one team owns the outcome.
Eligibility & Benefits Verification
Real-time checks on deductibles, copays, session limits and behavioral carve-outs before the first visit.
Prior Authorization Management
We request, track and renew auths for therapy, testing, IOP/PHP and medication management.
Claims Submission & Scrubbing
Behavioral health rule sets catch coding and modifier errors before payers ever see the claim.
Rejection / Denial Management & Appeals
Root-cause analysis, payer-specific appeal packets and parity-law escalation when plans underpay.
Payment Posting & Reconciliation
ERA/EOB posting with line-level variance checks against contracted rates — no silent underpayments.
A/R Follow-Up & Recovery
Proactive follow-up on every unpaid claim past its payer window, plus recovery of aged receivables.
Patient Billing & Statements
Clear, compassionate statements and payment plans that protect the therapeutic relationship.
Reporting & Revenue Insights
Clear reports on A/R aging, denial reasons, payer mix and revenue per clinical hour.
Why CogniClaim
Specialists, not a generalist billing vendor
We work with behavioral health exclusively. That focus is the whole advantage.
Behavioral health coding depth
E/M visits (99202-99205, 99211-99215), diagnostic evaluations (90791, 90792), psychotherapy (90833, 90834, 90836, 90837, 90838, 90853), crisis (90839, 90840), interactive complexity (90785) and testing (96130-96139) — coded correctly the first time.
Higher clean-claim rate
Specialty scrubbing rules mean fewer touches per claim and dramatically shorter days in A/R.
A dedicated account manager
One named person who knows your payers, your clinicians and your cash-flow calendar. No ticket queues.
HIPAA-compliant processes, zero data sprawl
Every engagement starts with a signed BAA. We work directly inside your own EHR, clearinghouse and payer portals under HIPAA-compliant processes — PHI never leaves your systems to live in ours.
How it works
Four steps from first call to steady cash flow
- 1
Onboarding & practice assessment
We audit your last 90 days of claims (365 for Medicare/TRICARE), payer mix and A/R to find the leaks worth fixing first.
- 2
Setup & integration
Clearinghouse connections, payer setup and EHR integration — configured around your workflow, not ours.
- 3
Claims submission & tracking
Daily scrubbed submissions with proactive follow-up on every unpaid claim past its payer window.
- 4
Reporting & continuous optimization
Monthly reviews on denial trends, fee schedules and documentation gaps to keep collections climbing.
Our Standards
< 48h
Claim submission
< 30–40
Days in A/R
98%
Clean claim rate
1:1
Dedicated support
Bi-Weekly
Claim reporting
Pricing
Percentage-of-collections model — no hidden fees
We only get paid when you do. No setup costs, no per-claim charges, no surprise line items. Custom plans for solo practitioners through multi-location groups.
FAQ
Questions we get from practice owners
Contact
Get a free revenue audit
Send us a few details about your practice. We'll set up a quick call to learn about your billing setup, then dig into your claims data to show you the specific denials, underpayments, and auth gaps costing you money.
- hello@cogniclaim.net
- BAA signed before any PHI is shared