How a Behavioral Health Provider Recovered $404K and Strengthened Rolling A/R Performance
Download PDFA behavioral health provider was experiencing reimbursement delays caused by payer communication challenges, authorization denials, credentialing issues, and billing inconsistencies. Aging claims continued to accumulate while unresolved denials and delayed follow-ups placed ongoing pressure on cash flow.
Client Profile
Type: Behavioral Health Provider
Services: Behavioral Health and Therapy Services
Locations: Multiple Service Locations
Scope: Rolling A/R Recovery, Claims Follow-Up, Denial Resolution, Credentialing, and Revenue Cycle Optimization
The Problem
The provider's accounts receivable performance was being impacted by unresolved claims, prolonged payer response times, and recurring billing issues. Without a structured process for identifying and resolving these issues, revenue remained tied up in aging claims while new denials continued entering the A/R cycle.
Key Challenges
- Difficulty connecting with CareFirst representatives, often requiring 3 to 3.5 hours of wait time before reaching a live agent
- Authorization and credentialing denials are delaying reimbursement
- Lack of timely follow-up contributing to filing risks and delayed payments
- Billing inconsistencies resulting in avoidable denials and payment recoupments
Issues Detected
- Incorrect authorization denials
- Usage of POS 99 resulting in CareFirst denials
- Credentialing issues requiring appeals and enrollment documentation
- Lack of follow-up causing timely filing denials
- Standalone code 92507 billed alongside behavioral health services, resulting in denials
- Incorrect corrected claim submissions are causing payment recoupments due to improper ICN usages
- High-value claims denied pending COB updates from members
- POS 3 billed for federal plans that did not cover educational program services
- Cigna authorization denials caused by incorrect benefit verification
The Guide
Plutus Health partnered with the provider to improve rolling A/R performance through proactive denial management, payer engagement, and revenue cycle optimization. By identifying the root causes of reimbursement delays and aging claims, the team developed a structured approach to improve collections and reduce future exposure to denials
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