An AI-powered model designed specifically for behavioral
health reimbursement.
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Starting as low as 3.5% of collections.
Behavioral health reimbursement operates under different
rules, different scrutiny levels, and different payer behavior
patterns than most medical specialties.
Understanding those patterns is the difference between
submitting claims and actually optimizing collections.
We built an AI-powered model designed specifically for
behavioral health reimbursement.
Stop Submitting Claims.
Start Engineering Reimbursement.
By identifying risk signals early,
CPP reduces preventable denials and
surfaces underpayment exposure
before revenue is lost.
The Claim
Payment Probability
Model™
Powered by Behavioral Health AI
Behavioral health claims are not random.
They follow patterns — payer patterns, coding
patterns, documentation patterns.
The CPP Model™ evaluates those patterns
before submission.
Authorization status and expiration exposure
Coding distribution and reimbursement alignment
Documentation consistency with billed CPT level
Telehealth modifier compliance
Payer-specific denial history trends
The goal is not simply to collect. It is to
increase payment predictability.
The Numbers Behind
Behavioral Health Reimbursement
$300M+
Estimated behavioral health revenue lost annually due to underpayments
and billing gaps.
2x
Mental health claims are denied at nearly twice the rate of many other specialties
40-60%
Of therapists remain out-of-network, often due to payer complexity and administrative burden.
1 in 3
Mental health practices undercode sessions and
leave revenue behind.
Why Behavioral Health
RCM Behaves Differently
Mental health claims are subject to unique payer dynamics.
-
Prior authorizations are more common and more closely enforced.
-
Telehealth policies vary by payer and continue to evolve.
-
CPT codes such as 90834 and 90837 carry significant reimbursement differences tied to documentation requirements.
-
Medical necessity standards are applied with greater scrutiny.
-
Parity laws exist, yet behavioral health claims are frequently treated with narrower coverage interpretation.
Revenue cycle management in behavioral health is not simply about submission — it is about pattern recognition and risk mitigation
Built Exclusively
Around Mental Health Claims
We work only within behavioral health. Therapists,
Psychologists, Psychiatrists, LCSWs, and Behavioral
Health Service Organizations.
This specialization allows us to analyze:
-
CPT utilization patterns and undercoding trends
-
Authorization exposure across payer panels
-
Telehealth compliance risk
-
Documentation-to-code alignment
-
Medicaid H-code and T-code reimbursement structures
Behavioral health billing is not a vertical for us.
It is the foundation of our RCM model.
The Ellora Way
Our Approach: Data Before Decisions
1
We begin with a structured behavioral health RCM assessment supported by CPP analysis.
2
We analyze denial rates, payer mix concentration, CPT distribution, AR aging segmentation, authorization patterns, and telehealth modifier usage.
3
The objective is not simply to identify denials — but to understand systemic risk and where reimbursement predictability can be improved.
If there is a measurable opportunity to strengthen collections, we outline it clearly.
If not, you retain the findings with no obligation.
What We Manage
Within Behavioral Health RCM
Eligibility and benefits verification
Claim review and submission
Denial analysis and appeals
Insurance AR management
Payment posting and reporting transparency
You gain visibility into claim performance across payers, providers,
and codes — without internal administrative overload.
Built for the EHR You Already Use
Ellora is EHR-agnostic by design — built to work with your infrastructure, not replace it.
SimplePractice. TherapyNotes. TheraNest. AdvancedMD. Kareo. Athena. DrChrono. We work with them all.
And if you use a different system, we support that too. No forced migrations. No workflow disruption.
Just smarter billing layered onto the systems you already trust
Revenue Cycle Management
for Behavioral Health, Reframed
Mental health reimbursement is not simply a billing task. It is a compliance-sensitive, pattern-driven revenue system. When managed with behavioral health intelligence, denial rates decrease, coding accuracy improves, and reimbursement becomes more predictable.
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