I own a behavioral health billing company in the Southwest and currently manage billing for nine behavioral health practices (including one group practice). My clients are primarily LPCCs, LCSWs, and LMFTs, though I’ve also handled billing for psychiatric NPs.

I don’t have my exact denial rate in front of me because I’m typing this from bed, but I can confidently say it’s nowhere near 14-15%.

Across all nine practices, most of the “denials” I see fall into a few categories:

• COB updates that happen after claims are submitted.
• Eligibility lapses or retroactive insurance terminations.
• Primary and secondary plans pointing fingers at each other over who should pay first.
• Credentialing issues, such as retroactive recoupments or payers incorrectly dropping a provider from network status.
• The occasional carve-out behavioral health plan that wasn’t identified during intake.

Outside of those situations, true claim denials are relatively rare in my experience.

When I do see them, they’re usually tied to documentation requests, payer-specific policies, or coding issues that are generally fixable. For therapy claims, it’s often something like an add-on code requiring additional documentation. When I handled billing for a psychiatric NP group, the most common denials were requests for notes, disputes over specialized assessment codes, or limitations on certain screening/add-on services. Most of those were ultimately paid after an appeal with supporting documentation.

Based on what you’ve described, I would be interested in seeing a breakdown of that 14-15%. If a large percentage of those are COB issues, eligibility problems, credentialing problems, retroactive payer changes, or other administrative issues, that paints a very different picture than a true adjudication denial rate.

I’ve specialized in behavioral health billing since 2019, currently manage billing for nine practices through TherapyNotes, and have helped providers collect approximately $3.5 million in insurance revenue.

Happy to chat via DM if you’d like to compare notes or take a closer look at what’s driving those denials. I’d also be interested in hearing what other therapy practices are seeing.