Preventing Intake-Stage Denials in Mental Health
In the world of mental health billing, denials often feel like a back-end issue, something the billing team catches weeks later and tries to fix. But in reality, many denials originate much earlier, often in the very first interaction a patient has with your clinic: the intake process.
In this blog, we’ll explore the most common causes of intake-stage denials, why they’re so prevalent in mental health practices, and what you can do to prevent them, before they impact revenue.
Unlike general medical specialties, mental health practices often deal with:
- A high percentage of self-pay, Medicaid, and managed care patients
- Time-sensitive authorizations for therapy services
- Variable coverage for CPT codes based on diagnosis and session length
- Virtual or minimal-contact check-ins, especially for telehealth
Because of these nuances, even small intake mistakes like missing insurance details or failing to verify authorization can lead to delayed or denied payments weeks later.
And by the time it reaches billing, it’s often too late to fix.
The Most Common Intake-Stage Denial Triggers
Here are the most frequent errors we see during intake at mental health clinics:
1. Inadequate Insurance Verification
- Not confirming behavioral health carve-outs
- Missing plan-specific CPT coverage (e.g., some payers only cover 90834, not 90837)
- Not checking if telehealth services are reimbursable under the patient’s plan
2. Authorization Not Verified or Missing
- Many payers require pre-auth for the initial evaluation (90791) and certain therapy sessions
- Lack of tracking for how many authorized sessions remain
- Not documenting authorization numbers in the EHR/billing system
3. Incomplete Demographics
- Typos in DOB, policy ID, or subscriber name
- Missing secondary insurance info
- Not collecting updated information from returning patients
4. No Diagnosis at First Visit
- Some payers require a covered diagnosis even for the first session
- Claims denied due to “lack of medical necessity” when diagnosis is missing or vague
5. Patient No-Shows Without Rescheduling
- Appointments left open with no follow-up, but initial auth is still consumed
- Wasted auth slots and delayed revenue
The Financial Impact
Even a 10% denial rate on your first-session claims can:
- Delay revenue by 45–60+ days
- Increase workload on your billing team to chase corrections
- Lower clean claim rates and increase A/R days
- Cause patient frustration if claims are rejected or re-billed
And the worst part? Many of these denials were 100% preventable.
How to Prevent Intake-Stage Denials in Mental Health?
Here are five proven strategies:
1. Use a Behavioral Health-Specific Eligibility Checklist
Create a checklist that intake staff must complete before scheduling a session, including:
- BH carve-out status
- CPT code coverage
- Telehealth policies
- Auth requirements
2. Verify and Store Authorizations Properly
- Use a simple tracking system to monitor auth status
- Store auth numbers with expiration and session limits in the patient record
- Flag patients when remaining sessions are low
3. Train Front Desk on Payer-Specific Requirements
Most intake teams aren’t trained on payer nuances. A 30-minute training on “top 5 payer rules” can prevent hours of rework later.
4. Digitize and Audit Intake Forms
- Use digital intake forms with required fields
- Regularly audit 5–10 new patient entries each week to catch mistakes early
5. Align Intake and Billing Teams Weekly
Create a workflow where intake and billing meet for 5–10 minutes weekly to review any recurring issues or payer-specific changes. This simple alignment can prevent repeated mistakes.
Final Thoughts
In mental health billing, what happens at intake sets the tone for the entire revenue cycle. Denials that stem from front-end issues often go unnoticed until revenue is lost and recovery is slow, if not impossible.
The good news? With the right processes, training, and visibility, intake-stage denials can be drastically reduced.
At GoSource, we work with mental health providers to fix these issues where they start before they affect your bottom line.
👉 Want to learn more about how we help clinics improve intake accuracy and prevent denials? Let’s connect.
