Claims being denied because your billing system doesn't know that a 90837 and a 90834 bill differently depending on session length -- and your staff are correcting those coding errors manually after each denial?
Pre-authorisation limits getting missed because there's no system tracking how many sessions remain under each approval -- clients completing their authorised sessions without anyone knowing until the claim is rejected?
Mental Health Billing Software Development
Mental health billing has rules that general medical billing software doesn't know about -- 90837, 90834, and 90832 bill differently depending on session length, telehealth sessions require specific modifiers, pre-authorisation approvals expire by session count not by date, and EAP billing runs through a completely different claims process than insurance. Software built for general medicine applies those rules incorrectly or not at all.
We build custom billing software for therapy practices and behavioural health organisations. CPT code automation that knows the difference between a 53-minute and a 45-minute session, pre-auth tracking that alerts before sessions run out, and ERA posting that reconciles payments without manual intervention.
Mental health CPT code automation by session type and duration
Pre-authorisation tracking with session count alerts
Electronic claim submission and ERA posting
Patient billing portal with payment plan management
Mental health billing has modality-specific CPT codes, telehealth modifiers, pre-authorisation session limits, and EAP billing requirements that general medical billing software handles poorly. RaftLabs builds custom billing software for therapy practices and behavioural health organisations that need accurate CPT code automation, pre-auth session tracking, ERA posting, and patient billing -- all designed around the actual billing rules of behavioural health, not general medicine.
HIPAACompliant claims architecture
·CPTCode automation built-in
·FixedCost delivery
·12-14Week delivery cycles
Why mental health billing needs its own software
General medical billing software is built around procedure codes for a physical encounter -- a physician performs a procedure, the code is applied, the claim is submitted. Mental health billing is time-based. The same type of session bills differently depending on whether it ran 38 minutes, 45 minutes, or 53 minutes. The CPT code that applies to a 60-minute individual session with a psychiatrist is different from the code for a 60-minute session with a licensed counsellor. Telehealth sessions require a place-of-service modifier and, in some states, additional modifiers that a general billing system doesn't apply automatically. Group therapy sessions generate one session record but multiple claims, one per client. General billing software handles none of that correctly without significant manual intervention.
The complexity compounds for practices managing multiple payer relationships. EAP billing runs through a separate process with its own claim formats and reimbursement schedules. Pre-authorisation approvals are granted by session count, not by date, and the billing system needs to track how many approved sessions have been used to alert staff before the limit is reached. Practices billing both insurance and self-pay clients need sliding scale fee management and superbill generation alongside standard claim submission. The organisations that get this right build or customise their billing software to know these rules -- rather than relying on a system that treats a therapy session like a blood draw.
What we build
CPT code automation
Session type to CPT code mapping that accounts for duration -- 90837 for sessions 53 minutes or longer, 90834 for 38 to 52 minutes, 90832 for 16 to 37 minutes -- applied from the actual session duration recorded at close rather than requiring staff to select the code manually. Telehealth modifier application based on session delivery mode, with place-of-service code 02 and modifier 95 applied automatically when the appointment is a telehealth session. Group session codes applied correctly per member -- 90853 for group therapy -- with individual claim generation for each group participant from the single session record. Psychiatric evaluation codes, add-on codes, and crisis intervention codes mapped to the correct session types with payer-specific rule application where payers have non-standard requirements.
Insurance eligibility and pre-authorisation
Real-time eligibility verification run before each appointment, returning co-pay amount, deductible status, remaining mental health benefits, and in-network status for the provider -- without staff calling the payer. Pre-authorisation request tracking with session count management: the approved number of sessions is recorded at authorisation, sessions are counted down as claims are submitted, and alerts are triggered when the client has two sessions remaining under the current authorisation. Authorisation renewal tracking with reminders so staff initiate the renewal process before the existing authorisation expires rather than after a claim is denied. Payer-specific authorisation requirements tracked per provider and insurance panel so staff know which payers require prior authorisation for which session types.
Electronic claim submission
CMS-1500 and 837P electronic claim generation from the closed session record -- diagnosis codes, procedure codes, modifiers, rendering provider NPI, and place of service populated from the session data without manual re-entry. Clearinghouse integration for electronic submission with real-time claim status tracking so staff see acknowledgement, acceptance, and rejection status without logging into the clearinghouse separately. Rejection alerts with specific error codes and the claim fields that triggered the rejection so staff can correct and resubmit without guessing at the cause. Payer-specific claim edits applied before submission to catch known rejection triggers for each payer before the claim leaves the system.
ERA and payment posting
ERA file processing that reads electronic remittance advice files and applies payments, contractual adjustments, and denials to the correct claim and client account lines automatically. Secondary claim generation triggered when a primary payer pays less than the full balance and the client has secondary insurance -- ERA data from the primary payer is used to populate the secondary claim without manual transfer. Balance reconciliation shows the difference between billed amount, contracted rate, payment received, and patient responsibility at the claim level so billing staff can see where each account stands without manual calculation. Denial reason code analysis identifies which codes are driving the highest denial volume by payer, provider, and procedure code.
Patient billing and statements
Copay collection prompted at appointment completion with card-on-file charging so co-pays are collected at the session without a separate billing step. Patient statement generation that shows charges, insurance payments, adjustments, and outstanding patient balance in plain language rather than billing code format. Online payment portal where patients make payments, view their statement history, and set up payment plans -- reducing inbound billing calls from patients asking about their balance. Payment plan management with scheduled automatic charges, payment confirmation notifications, and failed payment alerts so plans are managed without manual tracking. Self-pay and sliding scale billing with fee tier management configured by the billing administrator.
Reporting and revenue analytics
Collection rate by payer showing the percentage of billed charges collected after adjustments, so the practice knows which payer relationships are performing and which have systematic underpayment. Denial analysis by rejection code, payer, and procedure code identifies patterns that, once corrected in the billing rules, reduce future denial volume. Accounts receivable aging by provider and payer shows outstanding balances bucketed by days outstanding so billing staff prioritise follow-up on the right accounts. Revenue per session type shows which service lines generate the most revenue per hour of clinician time, informing scheduling and capacity decisions. Monthly revenue trend reporting gives practice leadership a view of billing performance without exporting data from multiple systems.
Frequently asked questions
Mental health billing is time-based rather than procedure-based. The CPT code that applies to a therapy session depends on session duration and the type of provider delivering the service -- rules that general medical billing software doesn't apply automatically. Pre-authorisation in behavioural health is approved by session count, not by date or dollar amount, which requires a different tracking mechanism. EAP billing runs through a separate process with its own claim formats. Telehealth sessions require specific modifiers that vary by payer and state. Group therapy generates multiple claims from one session. Each of those differences requires billing logic designed for behavioural health rather than adapted from a general medical billing system.
Yes. EAP billing uses a different claims process than standard insurance -- typically paper or portal-based claim submission rather than 837P electronic submission, with reimbursement rates and session limits set by the EAP contract rather than a payer fee schedule. The billing system tracks EAP authorisations separately from insurance authorisations, applies the correct billing pathway based on the client's coverage type, and generates EAP-specific claim formats or superbills depending on what the EAP requires. EAP session counts are tracked alongside insurance pre-auth limits so staff have a single view of how many sessions remain under each coverage type for each client.
Telehealth billing modifiers are applied based on the session delivery mode recorded in the appointment record -- the billing system knows whether the session was in-person or telehealth and applies place-of-service code 02 and modifier 95 accordingly. For payers that have non-standard telehealth billing requirements -- some Medicaid managed care plans have their own modifier rules, some payers still require audio-only modifiers -- payer-specific rules are configured in the billing logic so the correct modifier combination is applied per payer without manual selection. State-specific telehealth billing requirements that affect which modifiers are required are built into the payer configuration rather than left to staff to remember on a claim-by-claim basis.
Integration is built for the clearinghouse your practice uses or selects. Common integrations include Availity, Change Healthcare, Trizetto, and Office Ally. We build the clearinghouse integration using the clearinghouse's API or secure file transfer specification so claims are submitted electronically and acknowledgement and rejection data are returned without staff logging into a separate clearinghouse portal. If you are currently without a clearinghouse or looking to change, we can advise on clearinghouse selection based on your payer mix and the technical integration options each clearinghouse supports.
