Claim Scrubbing for Behavioral Health: How Clean Claims Keep Your Practice Paid
Behavioral health practices face some of the highest claim denial rates in healthcare, and many of those denials are completely preventable. That's where claim scrubbing comes in: reviewing claims for errors before they're submitted to payers.
Across the industry, initial denial rates now sit at nearly 12%.[1] For behavioral health services, that number runs even higher, with denials occurring at rates up to 85% above comparable medical services.[2] The culprit is often errors that should have been caught before the claim ever left the building.
But for behavioral health practices, generic scrubbing isn't enough. Psychiatric codes, therapy modifiers, and program-specific rules add layers that standard tools weren't built to handle.
This guide covers how claim scrubbing works, the behavioral health-specific errors to watch for, and practical steps to improve your clean claim rate.
What Is Claim Scrubbing (And Why Does It Matter)?
Claim scrubbing is the step between finishing clinical documentation and submitting the claim. It's where you or your biller review each claim for errors that could cause a denial or delay.
The goal is a clean claim: one the payer can process without corrections. When a claim bounces back, it enters a rework cycle of investigation, correction, resubmission, and follow-up. That cycle costs real time and real money.
Industry benchmarks put the target clean claim rate at 95% or higher.[3] Behavioral health practices handling billing in-house often fall below that, especially for complex programs like ARMHS or CTSS.
Here's where the math gets uncomfortable. A Minnesota group practice with 10 providers submitting 800+ claims per month? Even a 5% error rate means 40 claims requiring rework every month. At 15 to 30 minutes per claim, that's 10 to 20 hours of staff time spent correcting preventable errors.[4]
That's time your team could spend on intake, scheduling, or supporting providers. Clean claim submission isn't just a billing metric. It's a direct measure of how efficiently your practice operates.
Why Generic Scrubbing Falls Short for Behavioral Health
Most EHR systems and clearinghouses include basic claim scrubbing. They check for missing required fields, invalid codes, and formatting errors. That catches the obvious problems. But claim scrubbing for behavioral health has rules on top of rules.
Psychotherapy add-on code pairings are a common pain point. Add-on codes 90833, 90836, and 90838 must be billed with specific primary therapy codes, and each corresponds to a different time range. A generic scrubber may accept both codes as individually valid without checking whether the pairing matches the documented session duration.
Telehealth modifiers create similar issues. Modifier 95, GT, and place-of-service code 10 all have payer-specific requirements that shift frequently. What one payer accepts, another denies.
Program-specific billing adds another layer. ARMHS, CTSS, EIDBI, and TCM each have their own coding and documentation requirements. Generic tools don't know these programs exist, let alone validate claims against their rules.
Then there's supervisory billing. Behavioral health practices commonly bill under a supervising provider's NPI. If the rendering provider's credentials don't match the payer's enrollment records, or if the supervisor/supervisee relationship isn't properly documented, the claim fails. This is one of the most common behavioral health-specific denial triggers.[5]
Consider this scenario: a therapist bills 90837 (individual psychotherapy, 53+ minutes) with add-on code 90836, but the documentation shows a 60-minute session. The correct add-on for that time frame is 90838. A generic scrubber validates both codes individually but doesn't flag the mismatch. The claim is denied.
The Most Common Claim Errors in Mental Health Billing
Knowing where errors hide makes them easier to catch. Here are six categories that drive most clean claims issues in mental health billing.
Patient data errors. Inactive insurance, wrong member ID, demographic mismatches. These are the most preventable: eligibility verification before the session catches nearly all of them. Recent data shows that missing or inaccurate claim data triggers half of all denials.[6]
Coding errors. Incorrect CPT codes, wrong or missing modifiers, diagnosis code mismatches. Behavioral health codes (90834, 90837, 90847, and others) require matching the service type, duration, and provider credential level. Getting any one of those wrong triggers a denial.
Documentation gaps. Medical necessity not supported, missing start/stop times, incomplete clinical notes. Payers increasingly scrutinize behavioral health claims, often demanding that evidence-based interventions tie directly to DSM-5 diagnostic criteria.[5] If the note doesn't support the billed code, the claim gets denied. Or worse: paid and then clawed back on audit.
Authorization failures. Services rendered without required prior authorization, or sessions that exceed the authorized limit. Different payers have different auth requirements, and they change without much notice.
Duplicate claims. Billing the same service twice, or overlapping service dates across therapy types. Individual and group therapy on the same day can trigger duplicate flags depending on payer rules.
Timely filing misses. Claims not submitted within the payer's filing deadline. This is permanent revenue loss. There's no appeal, no correction. The money is simply gone.
A clinic discovers during a monthly A/R review that a payer quietly changed its authorization rules for group therapy. Claims submitted over the past two months were denied for missing authorization. Catching this during scrubbing, not after denial, would have saved weeks of rework.
Five Ways to Strengthen Your Claim Scrubbing Process
Improving your clean claim rate doesn't require a complete billing overhaul. These five steps make a meaningful difference.
1. Start before the session. Verify eligibility, check authorization requirements, and confirm the rendering provider's credentials are current with each payer. Many claim scrubbing failures originate hours or days before the claim is even created.
2. Standardize your documentation. Use note templates that include everything payers look for: start/stop times, medical necessity language, and treatment goals tied to diagnosis. When clinical notes are consistently structured, coding accuracy improves and scrubbing catches more.
3. Layer automated and human review. Automated scrubbing catches formatting errors, code validity issues, and duplicates. Human review catches the things software can't: clinical nuance, payer relationship quirks, credential issues, and pattern recognition across claims. The combination is more reliable than either alone.
4. Track your denial patterns. Don't just fix individual denials. Look at what's getting denied repeatedly and why. If the same error shows up across multiple claims, that's a systemic issue to fix at the source, whether it's a documentation template, a coding practice, or a payer enrollment gap.
5. Submit promptly. Every day a clean claim sits unsubmitted is a day closer to the timely filing deadline. Establish a regular submission cadence (daily or twice-weekly) and stick to it.
A solo practitioner in Illinois started tracking her top denial reasons each quarter. She discovered that 60% of her denials were authorization-related. She adjusted her intake workflow to verify auth requirements before the first session. Within three months, her clean claim rate went from 88% to 96%.
The Case for a Dedicated Billing Team
Even the best in-house process has limits. Behavioral health billing is complex enough that many practices benefit from a team that does this full-time.
The value isn't just speed or volume. A dedicated coordinator and biller learn your providers, your payer mix, your coding patterns, and your common issues. They catch errors that software misses and that a rotating cast of billers never would.
Compare that with ticket-based billing companies where claims are processed by whoever is available. There's no continuity. No practice-specific knowledge. No one who notices that a rendering provider recently changed her NPI after a name change (a detail the software didn't catch because the old NPI was still technically active in the system).
That level of pattern recognition only comes from a billing team that knows your practice. It's also one of the reasons many practices find that the hidden costs of managing billing in-house outweigh the cost of a dedicated partner.
BreezyBilling's timely filing commitment adds another layer of accountability. If a filing deadline is missed, we cover the lost revenue. That's a level of ownership that software or a generic billing service can't match.
Not every practice needs to outsource. Some handle claim scrubbing and clean claim submission well on their own. For those who've tried and struggled, or who'd rather focus on clinical work, a dedicated billing partner is worth considering.
Cleaner Claims Start Before the Claim
Claim scrubbing is the difference between getting paid on the first submission and entering a costly cycle of denials, corrections, and resubmissions.
For behavioral health practices, generic processes aren't enough. The complexity of psychiatric codes, therapy modifiers, and program-specific rules demands both the right tools and the right expertise.
BreezyBilling combines behavioral health billing expertise with a dedicated account team that learns your practice inside and out. That means cleaner claims, fewer denials, and more time focused on clinical work.
If your practice is spending too much time chasing denied claims, we'd be happy to talk through your billing process. Reach out anytime.
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Sources
https://business.optum.com/en/insights/denials-index.html
https://www.counterforcehealth.org/post/mental-health-insurance-denial-complete-guide-to-appeal-under-parity-laws-templates/
https://www.vozohealth.com/blog/the-importance-of-a-95-clean-claim-rate-to-improve-healthcare-practice-revenue
https://www.getmagical.com/blog/what-is-a-claim-scrubber
https://simitreehc.com/simitree-blog/common-behavioral-health-billing-challenges-and-solutions/
https://www.experian.com/blogs/healthcare/state-of-claims-2025/
