Your denied claims
are recoverable.
We prove it.
Coastal Practice Medical Management assists behavioral health providers with claim investigations, denial analysis, payment recovery efforts, and insurer internal appeal submissions. Services are limited to carrier-level appeals and do not include external review, arbitration, legal representation, or clinical utilization review services.
We recover behavioral health claims. That is all we do.
Coastal Practice Medical Management assists behavioral health providers with claim investigations, denial analysis, payment recovery efforts, and insurer internal appeal submissions. Services are limited to carrier-level appeals — Levels 1 and 2 — and do not include external review, arbitration, legal representation, or clinical utilization review services.
We understand the nuances of commercial payer billing in Pennsylvania and New Jersey, the documentation demands of psychiatric E&M codes, and the specific patterns that cause solo therapists to have their 90837s denied without cause.
Our clients range from solo practitioners and small group practices to community mental health centers, treatment centers, and substance use programs across Pennsylvania, New Jersey, and beyond. Every engagement is handled directly and personally.
"Mental health providers do life-changing work. They deserve to be paid for every session, every claim, every time."
Behavioral health claims recovery. First. Always.
We are not a general billing company. Every service we offer is rooted in one mission — recovering revenue that behavioral health providers have already earned and been wrongfully denied.
Behavioral Health Claims Recovery & Internal Appeals Management
Coastal Practice Medical Management assists behavioral health providers with claim investigations, denial analysis, payment recovery efforts, and insurer internal appeal submissions. Services are limited to carrier-level internal appeals (Levels 1 and 2) and do not include external review, arbitration, legal representation, or clinical utilization review services.
- Claim investigation and denial root-cause analysis
- Level 1 internal appeal preparation and submission coordination
- Level 2 internal appeal preparation and submission coordination
- Denial Pattern Analysis — written report with prioritized action plan
- Mental Health Parity (MHPAEA) internal appeal strategies
- Out-of-Network Billing & Single Case Agreement Negotiation
- Behavioral Health Reimbursement Consulting
- Written outcome reports with recovered amounts
Behavioral Health Billing Support
Billing support is a secondary offering — available to practices that need targeted consulting on specific billing issues. We do not replace your billing system or staff. We work alongside your existing setup, including Office Ally, your clearinghouse, or your provider billing system.
- Billing workflow audit and targeted optimization
- CPT code and modifier review (2026 standards)
- EOB and ERA discrepancy analysis
- Telehealth billing compliance (modifiers 95, 93, POS 02/10)
- Prior authorization guidance and documentation support
- Works with Office Ally, Availity, and provider billing systems
- Payer-specific behavioral health billing requirement guidance
Denial Pattern Analysis
A one-time, fixed-scope diagnostic engagement that identifies the root causes of your denials and surfaces the recoverable revenue hiding in your aged claims. You get a complete written report — not a generic checklist, but a practice-specific analysis you can act on immediately.
- Complete written diagnostic report with root-cause findings
- Top denial drivers responsible for 70–80% of your revenue loss
- Prioritized action plan your billing staff can implement
- Line-item list of recoverable claims with estimated value
- Available for solo practices, groups, and CMHCs
- Fixed flat fee by practice size — no surprise charges
Out-of-Network Billing & Single Case Agreement Negotiation
Out-of-network patients don't have to mean lost revenue. We handle OON reimbursement work and negotiate Single Case Agreements directly with commercial payers — so your practice gets paid when an out-of-network patient walks in the door.
- OON benefits analysis and patient cost estimates
- Single Case Agreement (SCA) negotiation with commercial payers
- Gap exception requests and network adequacy arguments
- OON-specific appeals and reconsideration letters
- Commercial payers only — PA, NJ, and other states
- Per-case or engagement-based pricing available
Behavioral Health Client Intake Specialist
A non-clinical conversation for patients, families, and individuals who need help understanding their behavioral health options, clarifying their goals, identifying the right type of provider, and navigating the administrative steps — without diagnosis, treatment, or therapy of any kind. Four session lengths are available to fit your situation.
- Quick Clarity Session (15 min) — Focused answers to specific administrative questions or single provider type identification
- Foundational Navigation Session (30 min) — Overview of options, basic insurance review, primary provider matching, summary roadmap
- Comprehensive Roadmap (45 min) · Best Value — Personalized roadmap, call guides, detailed benefits review, specific provider matching
- Deep Dive & Support Session (60 min) — Complex cases, multi-diagnostic situations, family groups, deep insurance and provider navigation
- Available by phone or video — PA, NJ, and beyond
What sets us apart from every other billing firm.
There are dozens of medical billing companies. Very few specialize exclusively in behavioral health. Fewer still operate the way we do.
Behavioral Health Only
We do not split our attention across 15 medical specialties. Every engagement, every appeal, and every billing question we handle is rooted in behavioral health expertise — nothing else.
No Recovery, No Fee
Claims recovery is billed on pure contingency. If we do not recover money for you, you do not pay us. Your financial risk is zero — and our incentive to perform is absolute.
Direct Expert Access
You will never be handed off to a junior associate or a call center. Every engagement is handled personally by an expert with 23+ years of knowledge in behavioral health.
No Long-Term Contracts
Every engagement is project-based. We earn your continued business through results — not by locking you into a contract. Start with one engagement and evaluate from there.
PA & NJ Payer Expertise
HealthChoices BH-MCOs, NJ FamilyCare, IBX, Horizon, and all the regional nuances that national firms miss. We operate in your market and know your payers.
Remote & Fully Flexible
We work entirely remotely, fitting into your practice workflow without disrupting it. Available to practices of every size — solo therapists to multi-provider groups to CMHCs.
Serving providers across PA, NJ & beyond.
We have deep knowledge of commercial payer landscapes in Pennsylvania and New Jersey, and we welcome inquiries from providers in other states.
Ready to get started? Complete your intake form.
New clients can complete our intake form to help us understand your practice, your payers, and your situation before our first conversation — so we can hit the ground running.
Practice & Billing Intake Form
For behavioral health practices and providers inquiring about claims recovery, billing support, denial analysis, or OON negotiation services. Takes approximately 5–8 minutes.
Patient & Family Navigation Request
For individuals and families seeking help understanding behavioral health care options, insurance navigation, and provider matching. Non-clinical. Four session lengths available — from a 15-minute Quick Clarity to a 60-minute Deep Dive.
All submissions are kept strictly confidential. Do not include Protected Health Information in any web form.
Billing knowledge for behavioral health providers.
Practical guidance on claims, billing, and revenue cycle management — written specifically for mental health and psychiatric practices.
Why Your 90837 Keeps Getting Denied — And What to Do About It
If your 90837 claims are coming back denied, the problem is rarely the service itself. Payers look at session documentation, authorization status, and modifier usage before they pay — and one missing element can trigger an automatic denial. The good news is that most of these denials are fully appealable with the right approach.
Read Full Article →MHPAEA in 2026: How to Use Parity Law to Win Appeals You Think You Have Lost
The Mental Health Parity and Addiction Equity Act requires insurers to cover behavioral health services on equal terms with medical and surgical care. When a payer denies a mental health claim that would have been approved for a comparable medical service, that denial may be a parity violation — and a winnable appeal. Most practices never use this powerful tool.
Read Full Article →Modifier 95 vs. Modifier 93: Getting Telehealth Billing Right in 2026
In 2026, audio-only behavioral health telehealth is permanently reimbursable under Medicare — but only when billed correctly. Modifier 95 covers live video sessions, while Modifier 93 is required for audio-only. Using the wrong modifier, the wrong Place of Service code, or forgetting to document why video was not used will result in an immediate denial that most practices never recover.
Read Full Article →PA HealthChoices BH-MCO Billing: What Every Provider Needs to Know
Pennsylvania's behavioral health Medicaid program operates through county-based managed care organizations — and billing rules vary by MCO, by county, and by service type. Whether you are credentialed with CCBH, PerformCare, Magellan, or Value Behavioral Health, understanding the specific documentation and prior authorization requirements for your region is critical to getting paid consistently.
Read Full Article →Solo Therapist's Guide to Insurance Billing: What to Do When Payers Push Back
Solo practitioners are often left to navigate insurance billing entirely on their own — and payer pushback can feel personal and overwhelming when it is not. The most common denial types for independent therapists are entirely predictable, and most have clear, straightforward responses. Knowing what to do in the first 30 days after a denial makes the difference between recovered revenue and a write-off.
Read Full Article →Is Your Practice Leaving Money on the Table? A 5-Minute Billing Audit Checklist
Most behavioral health practices have no idea how much revenue is sitting in their denial queue — unworked, aging, and approaching timely filing deadlines. A quick internal audit of five key billing metrics can reveal whether your practice has a denial management gap and how much it may be costing you every month. Here is where to start.
Read Full Article →The February 2026 HIPAA Deadline Your Practice May Have Already Missed
February 16, 2026 was the federal compliance deadline requiring covered entities to update their Notice of Privacy Practices to reflect major 42 CFR Part 2 changes. These updates are not limited to traditional substance use disorder providers — if your behavioral health practice touches SUD records through any care coordination, integrated care model, or health plan arrangement, you are likely in scope. Here is what changed, why it matters, and what to do if you have not yet acted.
Read Full Article →The HIPAA Security Rule Is Being Rewritten: What Behavioral Health Practices Must Do Now
The most significant overhaul of the HIPAA Security Rule since its original adoption is underway. Proposed changes include mandatory multi-factor authentication for all ePHI access, encryption of all electronic protected health information at rest and in transit, vulnerability scanning every six months, annual penetration testing, and 72-hour breach notification to HHS. For behavioral health practices — where sensitive psychiatric and SUD records are routine — the compliance stakes are especially high. Here is what is coming and how to prepare before the final rule lands.
Read Full Article →Answers to your most common questions.
Transparency matters to us. If you have a question not covered here, reach out directly — we are always happy to talk.
Our claims recovery service is billed on a pure contingency basis — meaning we only charge a fee when we successfully recover funds on your behalf. If we pursue an appeal and it is not successful, you owe nothing for that claim.
Our fee is a percentage of the net amount actually recovered and paid to your practice. The applicable percentage is agreed upon in writing before we begin any engagement and is documented in your Service Order. Fees are invoiced after confirmed payment receipt by your practice.
Coastal Practice Medical Management prepares all Level 1 and Level 2 internal appeal documentation, letters, and resubmission strategies — coordinated through your existing billing software or billing staff. This means we do not need direct access to your practice management system, and your PHI stays within your existing secure environment. Services are limited to carrier-level internal appeals and do not include external review or arbitration.
This model is intentional: it keeps your practice in control of your systems, reduces compliance complexity, and allows us to work with any billing platform you currently use.
We work with behavioral health and mental health providers of all sizes across PA, NJ, and beyond — including solo practitioners (LCSWs, LPCs, LMFTs, psychologists, psychiatrists, PMHNPs), small and mid-size group practices, community mental health centers (CMHCs and CCBHCs), treatment centers, and substance use programs.
Every engagement is tailored to the size and complexity of your practice. A solo therapist and a 15-provider group have very different needs, and we approach them accordingly.
It depends on the payer and the nature of the denial. Level 1 internal appeals to commercial payers typically take 30 to 60 days for a determination. Level 2 internal appeals may take an additional 30 to 60 days. Timelines vary by payer and plan type. Coastal Practice Medical Management handles Levels 1 and 2 carrier-level internal appeals only and does not handle external review, arbitration, or legal proceedings.
We keep you informed throughout the process with regular status updates, and we provide a written outcome report at the close of each engagement regardless of the result.
CPMM serves commercial payers only — including Horizon BCBS, IBX, Aetna, Cigna, UnitedHealthcare, and other commercial insurers operating in PA, NJ, and beyond. We do not handle Medicare, Medicaid, or any government-payer claims.
If you have questions about whether your specific payers fall within our service scope, please reach out and we will be happy to clarify before any engagement begins.
No. We work with practices of all sizes and volumes. Whether you have a handful of specific denied claims that need to be appealed, or a larger backlog of unworked denials to address, we can structure an engagement that fits your situation.
We recommend starting with a complimentary initial review — we will look at your denial trends and tell you honestly what we believe is recoverable and what the engagement would look like before any commitment is made.
An upfront engagement fee is assessed at the time of contract signing for claims recovery engagements. This fee covers initial claim review, intake, documentation analysis, and payer research — the foundational work required before appeals can be filed.
The fee varies based on the size and complexity of your practice and is fully credited against the recovery fee upon successful resolution of your claims. For billing support engagements, fees are flat-rate per project with no upfront fee — pricing is confirmed in writing before work begins.
No. Every engagement is project-based. Our master Services Agreement governs the overall relationship, but each project is initiated through a separate Service Order that specifies exactly what work will be done, the timeline, and the fee structure.
You are never locked into ongoing services. We earn your continued business through results — and we are confident enough in our work to let that speak for itself.
A Denial Pattern Analysis is a one-time, fixed-scope diagnostic engagement. We review your denied and aged claims, identify the root causes driving the majority of your revenue loss, and deliver a complete written report with a prioritized action plan and a line-item list of recoverable claims.
It is ideal for practices that know they have a denial problem but are not sure where it is coming from — or for practices that want a clear picture of what is sitting in their denial queue before deciding whether to pursue a full recovery engagement. It is priced flat by practice size and requires no ongoing commitment.
A Single Case Agreement (SCA) is a one-time contract between your practice and a commercial payer that allows you to be reimbursed at an agreed-upon rate for a specific out-of-network patient. Rather than losing the patient or billing at steeply reduced OON rates, we negotiate directly with the payer on your behalf to secure a case-by-case in-network equivalent or near-equivalent rate.
This service is commercial payers only. We handle the entire negotiation process — from initial outreach and network adequacy documentation to gap exception requests and final agreement confirmation. You continue providing care; we handle the payer relationship.
Neither. CPMM is an independent consulting practice. We are not a billing clearinghouse, a staffing agency, or a large RCM firm with a call center. Every engagement is handled directly and personally by an experienced behavioral health billing consultant with 23+ years of knowledge in this specialty.
This matters because when you work with CPMM, you are not assigned to a team, handed off to a junior associate, or placed in a queue. You work directly with the person who will actually do the work — from intake to outcome report.
Yes — we are open to working with practices in other states, particularly for commercial payer services. Claims recovery, Denial Pattern Analysis, and Out-of-Network / Single Case Agreement work are largely portable across state lines because they are driven by commercial payer policies rather than state-specific Medicaid programs.
If you are located outside PA or NJ, reach out and describe your situation. We will tell you honestly whether we can help and what that engagement would look like. We would rather have that conversation than have you assume we cannot serve you.
Ready to recover behavioral health revenue your practice has already earned?
Start with a claims review. Tell us what you are dealing with — denied claims, a pattern of underpayments, a parity issue. We will tell you honestly what we think is recoverable.