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Increasing Your Approval Rates in Behavioral Health Billing

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Billing for medical procedures, such as an MRI, is relatively straightforward; however, billing and billing software for behavioral health treatment services is unquestionably unique. Insurance companies can have vastly different requirements for mental health treatments like counseling services. And because of the challenges they face, most behavioral health care providers only collect a portion of the claims they are legitimately owed.

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To make matters worse, billing complexity can equate to hours of manual effort if providers don’t have proper billing systems in place. Those hours of effort can take away from hours of treatment – and mental health treatment is irreplaceable – especially as our nation faces increasing rates of depression and anxiety.

Having a billing platform purpose-built for behavioral health may drastically reduce your manual efforts, increase billing efficiency, and result in more claim approvals. Sunwave’s advanced billing engine uses over 150 validation rules to ensure clean claims to reduce common mistakes and issues. This helps to automatically generate claims per your defined parameters while meeting different insurance requirements. Now, let’s take a look at key steps to improve claim approval rates.

Seven Key Steps to Behavioral Health Billing Success:


  1. Leverage a Billing Software for Behavioral Health – there are many platforms on the market for medical billing; however, as we mentioned above, traditional medical service billing is a lot less complex than behavioral health treatment billing. Using a tool that was purpose-built and understands the behavioral health intricacies will help you process cleaner claims and get reimbursements faster.
  2. Receive Preapproval for Treatment – there’s an old saying, “it’s easier to ask for forgiveness than it is to get permission,” but that doesn’t hold true with insurance providers. Your claim processing efforts will be a lot more efficient when you understand what is preauthorized.
  3. Make Sure the Patient’s Insurance Information is Correct – as simple as this recommendation may sound, insurance changes happen often, and sometimes the insured isn’t even aware of the change. Submitting a claim to a company that no longer insures your patient can not only delay reimbursement but may even prevent you from receiving any compensation if the patient no longer carries insurance. In Sunwave’s behavioral health RCM, you can configure it to verify benefits automatically on a schedule – that way, if a patient’s policy is cancelled while in treatment, you’ll know very quickly and not have to wait for denied claims to find out.
  4. Format According to the Insurance Company Requirements – different insurance companies may prefer different forms than others. It is critical to know what each insurance company prefers in order to expedite your claims and receive better approval rates.
  5. Use the Right Diagnosis & Treatment Codes – coding has gotten a bit more complicated over the years, and having the right codes can significantly improve reimbursement rates. For example, some therapy codes require a certain amount of face-to-face time, and if you bill using a code that requires more face time than was actually delivered, your claim will likely be denied.
  6. Ensure it’s the Correct Billing Address – many insurance providers have a different billing address than their primary or corporate address, and you don’t want to rely on it getting forwarded to the right place.
  7. File Claims Within the Given Timeframe – expediency is key for your cash flow and claim approvals. Ensure your team has the tools to process clean claims quickly to prevent delays or denials of reimbursement.

Sunwave’s billing platform can help your team process claims faster and more accurately, leading to more claim approvals. And because we built a comprehensive platform for all operations in behavioral health and SUD treatment facilities, it’s not just your claim approvals that can improve but also other top KPI factors but also other top KPI factors. Sunwave will give you full transparency across all operations and the complete patient lifecycle, helping you optimize your processes, admit more patients, and deliver better care. To learn more and speak with one of our platform experts, schedule a demo – we’ll be happy to show you how Sunwave can help.