If you’re a mental health provider, or run a small private practice, denied claims can feel like death by a thousand paper cuts. One day you’re expecting a payment, the next you’re chasing a rejection with no clear answer. For many practices, insurance billing feels like a constant guessing game: what went wrong this time?
But claim denials aren’t random. They’re almost always tied to predictable patterns. Patterns that, once identified, can be fixed.
At Fireball Studio, we specialize in helping providers uncover the real reasons behind delayed or denied payments and fix them at the root. Because when clean claims go out the first time, money comes in faster, stress goes down, and your business runs like it’s supposed to.
Let’s break down the most common errors I see and how to prevent them.
- Payer Errors: When the Problem Isn’t You (But You Still Pay for It)
Yes, sometimes the denial is the payer’s fault. But here’s the catch: unless you have the systems in place to catch and respond to those errors, you’ll lose money anyway.
Common examples include:
- Incorrectly applied eligibility dates
- Missing authorization or referral information the provider submitted
- Claims incorrectly marked as duplicates
One recent client, a small counseling group, was losing thousands every quarter due to these kinds of issues. They’d submit clean claims, but when the payer system didn’t update their provider roster correctly, the claims got kicked back. No one followed up because the billing staff didn’t have time.
The fix? We set up a structured follow-up workflow, automated eligibility checks, and escalated provider roster errors directly to the payer’s rep. Within 30 days, over $7,500 in backlogged payments were recovered.
Tip: Just because a payer denies something doesn’t mean they’re right. Always verify before writing anything off.
- Coding Mismatches: When One Wrong Number Stops the Whole Claim
Insurance billing is full of nuance. A single incorrect CPT code, missing modifier, or mismatched diagnosis can hold up an otherwise valid claim.
Here are a few examples that trip up mental health providers:
- Using time-based therapy codes incorrectly (e.g., 90837 without proper documentation)
- Forgetting to add the telehealth modifier (like -95 or GT)
- Inconsistent use of place of service codes (especially for hybrid practices)
- Pairing an invalid diagnosis with a code not supported by that diagnosis
And when it’s out of network? Add another layer of complexity. I once worked with a practice that kept getting denials for 90834 sessions. The problem? Their documentation didn’t support the session length, and the payer required a different modifier for out-of-network claims. Small errors, big impact.
Tip: If you’re using templated notes or generic codes, it’s time to review your billing logic. Clean claims start with clean documentation.
- Missing or Incomplete Information: The Hidden Profit Killer
You’d be shocked how many claims get denied or delayed over things that should be easy to catch, like:
- Misspelled patient names
- Incorrect insurance ID numbers
- Missing date of birth
- Invalid referring provider NPI
- Outdated insurance cards on file
These “clerical” errors are often brushed off as minor, but they compound quickly. A single missing digit in a member ID can delay a claim by weeks.
One solo provider I worked with had a backlog of 80+ claims stuck in limbo. We discovered that nearly 60% of them were missing some kind of basic information. Most often because front desk intake forms weren’t being reviewed before submission. A simple checklist and digital intake overhaul cut those errors down by 90% within two weeks.
Tip: Intake is part of billing. Make sure whoever handles it knows that accuracy matters from day one.
- The Denial Domino Effect: When One Problem Leads to Another
Here’s what happens in most small practices:
- A claim gets denied.
- No one has time to follow up, or the system doesn’t flag it clearly.
- It gets refiled without fixing the issue—or worse, forgotten.
- Future claims for the same patient or provider get auto-denied because the root problem wasn’t addressed.
And now you’ve got a whole stack of denied claims, a stressed-out biller, and a frustrated provider wondering why revenue is suddenly down.
That’s why denial management is not just about fixing rejections, it’s about preventing them in the first place. That means having a system to:
- Track denials in real time
- Categorize them by reason and payer
- Fix the root cause
- Resubmit clean claims with proper documentation
The Bottom Line: Denials Are a Symptom, Not the Disease
When we do a free claims audit for new clients, we’re not just looking at what’s not getting paid, we’re looking at why. Because once you know the patterns, you can prevent the rejections.
The result? More revenue, fewer headaches, and a billing process that supports your practice instead of stalling it.
You didn’t get into this work to fight insurance companies. Let us handle that part, so you can focus on what you do best: caring for your clients.
Free claims audit for new clients—message me today.
Let’s find out what’s holding your claims up and get your billing back on track.