How to Verify Eligibility and Benefits for Behavioral Health Providers?

Denied claims can be challenging to handle for the behavioral health practitioners who take insurance.

“You really did a great job in therapy services, but we are not giving you any penny for it!”

When it comes to personal billing, preventing denied claims can be one of the time savers. You cannot spend more time ensuring whether you are filing the correct thing unless you are filing enough. It is also not worth the time and effort to see a patient multiple times, wait for the billing until the end of the month, and then file only to realize that these patients are not even eligible for behavioral health benefits.

How would you feel when you find out after a month-long service that these patients have an outstanding deductible or that your practice is not within their network and only reimburse the within-network providers?

Even worse: your patients are thoroughly covered, but your practice information does not match the insurance company’s information.


This article will guide you with a walkthrough about how to never get behavioral health claims denied again. This is a preventive tactic and cannot be used after the filing is done.

24/7 Medical Billing Services do this entire thing from front-end to back-end with the exclusive behavioral billing services

 for the healthcare providers. If you are also interested, do reach out to us!

Prevent Behavioral Health Denied Claims by…

Make sure to verify the eligibility and benefits of your new behavioral patients over the call!

It’s very simple, and you’ve to do it only once per new patient. (Don’t tell other behavioral billing companies we’re telling you the secret)

You will never deal with the denied behavioral claims again if you confirm with them over the phone that:

  1. You are in-network
  2. Your information is correct
  3. Your new patient is eligible for your outpatient services

Check Eligibility and Benefits by….

Before you begin with the process, make sure you’re ready with a bit of information as:

Healthcare Provider Related Information:

  1. Your Tax ID or Social Security Number (SSN) or Employee Identification Number (EIN)
  2. Your NPI Number
  3. Your License Number (not required often)
  4. Your service address

Patient-Related Information:

  1. Date of Birth (DOB)
  2. Address
  3. First and Last Name of Subscriber
  4. ID Number of Subscriber
  5. First and Last Name of Insured
  6. Relationship with Insured (self, spouse, child)

Ideally, you should have the subscriber’s insurance card photocopy (front and back). If you don’t have or don’t ask for it, do remember in the future! In fact, a simple photo of such an insurance card from your smartphone will be more than sufficient.

A Simple Eligibility and Benefits Phone Call Script

It’s time to pick up the phone and call your favorite insurance company to verify your new patient’s coverage.

Here is a script that can help you in covering all the major points. Most insurance representatives will guide you through this process. Ask some of these additional questions along with the essential clarity, “I’m looking to verify the eligibility and benefits for outpatient behavioral health services for a new patient.” Before I begin, I want to make sure that I am within the network provider for your panel,

  1. Can you please check?
  2. Sounds Good. I want to cross-check that you have my correct office address; it’s…….
  3. The subscriber’s first and last name, ID, and date of birth are……
  4. Is there any authorization or limit required for this patient?
  5. Can you confirm the following CPT codes: 90834, 90847, and so on? (add CPT codes you’re going to bill)
  6. I want to confirm the coinsurance or copayment for this patient?
  7. Is there any outstanding deductible for this patient?
  8. Where shall I send my claims?
  9. What about the Payer ID for e-claims?
  10. Thanks for your assistance; can you help me with your name and a reference ID for this phone call for record purposes?

Viola!  Now, you have all the necessary information to file your claims successfully. If anything goes wrong, you know how to reference the call to get the claims corrected.

Make sure to take notes in the call since these will be important for charging your new patient’s copayment.

Do you find it repetitive to go through this process whenever there is a new patient? We can do this all and more for you. Reach out to us and learn about how we can help you with behavioral billing services.

The Secret of Skipping the Insurance Prompts is…

Call the insurance providers on the hotlines and go through the prompt that asks about the eligibility and benefits.

Simply wait on the phone without saying a word. After waiting for a while, start saying all these words on the phone!

  • Agent
  • Operator
  • Representative
  • Customer service
  • Customer support

Moreover, press the zero (0) button on your smartphone’s keypad.

(True secret- Outsource it to 24/7 Medical Billing Services)

Filing & Checking Up

It’s now time to file the claims. Refer to the notes from your eligibility call and use all the right subscribers and address information on the claims form.

Whether you have filed the claims electronically or in papers, you should ideally call the insurance company and confirm the submission. Do this only once so that you can avoid any further follow-ups in the future. Moreover, you must wait at least two business weeks for electronic claims and around three and a half weeks for the paper claims.


Most of the claims get denied because the patient is not eligible for your services more often than not. The second most common cause is that your information does not match the insurance provider’s information. Call to verify both and get the claims settled quickly with the tips from this article.

Read more:  5 Smart Ways To Get Your Behavioral Health Claims Paid Faster!

Let us know what you need!

Error: Contact form not found.