How a Behavioral Health Provider Recovered $404K and Strengthened Rolling A/R Performance
A 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