Verification of Benefits for Mental Health Clinics

Verifying your patients is an important part of your clinic’s operations. Unfortunately, one of the number one reasons that claims get denied is due to eligibility errors. In order to minimize these errors, it is important to do a comprehensive verification of benefits so you know exactly what the patient’s plan covers before seeing them. A comprehensive verification usually includes placing a phone call to the payer so you make sure you understand the patient’s benefits.

First, it’s important to make you collect the following information from the patient:

• Date of Birth
• First & Last Name
• Subscriber ID Number

Next, you can use Availity or another clearinghouse to understand high level what the patient’s plan includes. It serves as a great base so you have an understanding of the plan before you call the payer.

Last, is the call to the payer. It’s best to have a script that you use each time you call the payer so you know exactly what to ask the representative when you get in touch with them.

1. Ask for mental health provider eligibility and benefits 
2. Confirm your network status with the rep
3. Provide the rep with the patient information you have
4. Confirm that there are no limitations or authorizations for this plan for mental health services
5. Confirm that the following CPT codes: 90791, 90834, 90837, 90847” have no limitations or authorizations
6. Ask what the copay or coinsurance for this patient?
7. Ask if the patient have an outstanding deductible?
8. Ask the rep for their name and call reference ID

The most common causes of denied mental health claims are due to 

• Problems with diagnosis – incorrect or incomplete diagnosis codes
• Prior authorization required and not obtained
• Exceeding limitations 

If you are interested in learning how One Body can help you and your office with calling payers and verifying your patients’ benefits, please fill out the contact form below.