Denial appeals · Behavioral & mental health
Payers second-guess therapy more than any other care. We make them justify it — or pay.
Behavioral health practices face a specific gauntlet: 90837 scrutiny, telehealth modifier denials, auth fights on higher levels of care, and 'frequency' pushback on the exact cadence your treatment plan calls for. Most go unappealed. That's revenue.
Free for your first 10 claims. Then 15% of recovered revenue only — upheld denials cost you nothing.
The denials you're seeing
We know these EOBs by heart.
| Denial | What the payer said | Why it's often winnable |
|---|---|---|
| CO-50 | Not medically necessary — 60-min sessions (90837) | Payers pressure 90837 down to 90834. When session length is clinically driven and documented, their own criteria support the longer code. |
| Telehealth | Wrong POS / modifier (95, GT, POS 02/10) denials | Telehealth billing rules changed repeatedly; payers deny on outdated edits. These are correctable, citable, and recoverable. |
| CO-197 | No prior auth — IOP, PHP, testing | Retro-auth provisions, urgent-need exceptions, and parity obligations give these appeals real teeth. |
| CO-151 | Frequency — 'too many sessions' | Treatment-plan-supported cadence plus mental health parity requirements make blanket frequency denials vulnerable. |
| CO-16 | Missing information — diagnosis specificity, credentials | Usually a correctable defect: a missing taxonomy or supervisor co-signature. We name the cure. |
How we fight them
Specialty-specific arguments, not form letters.
MHPAEA arguments
Federal parity law bars payers from applying stricter limits to mental health than to medical care. Few appeal letters invoke it. Ours do, where the facts support it.
Session-length documentation
We tie documented clinical complexity to the payer's own coding guidance, making the 60-minute session the supported choice — not the flagged one.
Modifier & POS corrections
A large share of behavioral telehealth denials are payer-side edit errors. We cite the payer's current telehealth policy version against their own denial.
Free 10-claim pilot
Find out what your write-offs were actually worth.
Tell us a little about your practice. We'll reply within one business day with the BAA and a secure upload link.