Behavioral Health Billing – How to Verify Eligibility and Benefits?

eligibility and benefits verification services

The handling of denied claims might be difficult for behavioral health professionals that accept insurance.

Preventing refused claims can be one of the time saves in personal billing. If you are not filing enough, you will not have time to spend more time making sure that you are filing the right item. Additionally, it is inefficient to schedule several appointments with a patient, wait until the end of the month for the billing, and then submit paperwork only to learn that the patient is not even qualified for behavioral health insurance verification.

How would you feel if, following a month of care, you learned that these patients have an unmet deductible or that only in-network physicians get reimbursed on their behalf?

Even worse: although your practice’s information does not match that of the insurance provider, your patients are fully insured.

Prevent Denied Claims for Behavioral Health

Make sure to call your new behavioral patients and confirm their benefits and eligibility!

It’s very easy, and you only need to complete it once for each new patient. If you confirm over the phone that with the person who refuted the behavioral claims:

  • You are connected
  • Your data is accurate.
  • Your outpatient services are available to your new patient.

Verify Benefits and Eligibility

Make sure you have some background knowledge before you start the process, such as:

Information pertaining to the healthcare provider:

Your Social Security Number (SSN), Tax Identification Number, or Employee Identification Number (EIN)

  • NPI Number for You
  • A license number is (not required often)
  • Your contact information

Information regarding the patient:

  • Date of Birth (DOB)
  • Address
  • First and Last Name of Subscriber
  • ID Number of Subscriber
  • First and Last Name of Insured
  • Relationship with Insured (self, spouse, child)

Ideally, you ought to have a photocopy of the subscriber’s insurance card (front and back). Do keep that in mind for the future if you don’t have it or don’t ask for it. Actually, a straightforward photo of such an insurance card taken with your smartphone will be more than enough

A Basic Benefits and Eligibility Phone Call Script

It’s time to pick up the phone and contact your preferred insurance provider to confirm the coverage for your new patient.

This script might assist you in covering all the important aspects. The majority of insurance agents will walk you through this procedure. Along with the crucial clarification, state, “I’m looking to verify the eligibility and benefits for outpatient behavioral health treatments for a new patient.” Ask some of these additional questions. I want to make sure I am within the network provider for your panel before I start.

  • Can you please check?
  • Sounds Good. I want to cross-check that you have my correct office address
  • The subscriber’s first and last name, ID, and date of birth
  • Is there any authorization or limit required for this patient?
  • Can you confirm the following CPT codes: 90834, 90847, and so on? (add CPT codes you’re going to bill)
  • I want to confirm the coinsurance or copayment for this patient?
  • Is there any outstanding deductible for this patient?
  • Where shall I send my claims?
  • What about the Payer ID for e-claims?
  • Thanks for your assistance; can you help me with your name and a reference ID for this phone call for record purposes?

You now have all the information required to effectively file your claims. You know how to refer back to the call if something goes wrong to have the claims rectified.

During the call, make sure to take notes because you’ll need them to charge your new patient’s copayment.

Do you think it is boring to have to go through this every time there is a new patient? For you, we can accomplish all of this and more. Contact us to find out how we can provide behavioral health billing services for you.

Secret of Skipping the Insurance Prompts

Call the hotlines for the insurance companies and follow the prompts when they ask about eligibility and benefits.

Simply hang up the phone and wait without speaking. Start saying all of these words on the phone after some time has passed.

  • Agent
  • Operator
  • Representative
  • Customer service
  • Customer support

Sorting & Verifying

The time has come to submit the claims. When filling out the claims form, utilize the correct subscribers and addresses and make reference to the notes from your eligibility call.

Regardless of whether you submitted the claims electronically or on paper, you should call the insurance provider to confirm receipt. Just once should be done in order to prevent subsequent follow-ups. Additionally, it takes around three and a half weeks for paper claims to be processed and at least two business weeks for electronic claims.


Because the patient is frequently ineligible for your services, the majority of claims are rejected. Your information not matching that of the insurance provider is the second most frequent reason. Utilizing the advice from this post, call to confirm both and promptly resolve the claims.

Leave a Reply

Your email address will not be published. Required fields are marked *