How to judge a mental health billing company
Judge a mental health billing company on six things before you sign. First, the fee and its basis. A percentage of the allowed amount, a percentage of collections and a flat monthly fee can produce very different invoices for the same month. Second, what's included. Some billing companies start when a claim is ready and stop at payment posting. Others also check benefits, collect patient balances or handle credentialing. Third, who does the work. Ask who works your account, whether you get a named contact, and how quickly they reply. Fourth, the contract. Look for the notice period, setup fees, minimums and what happens to open claims if you leave. Fifth, the business associate agreement. HHS lists claims processing and billing among the activities a business associate performs, so get a signed BAA before anyone sees client records. Sixth, claim status. You should be able to check the status of any claim yourself, without emailing someone and waiting.
Ask where each company's work starts. TheraThink's FAQ, for example, has your staff notify it about a new or prospective client, and it verifies benefits from there. Resilience Billing checks benefits before the first appointment, and The Bowerbirds and Cortexa also take on parts of intake. If denials keep tracing back to a mistyped member ID or a plan booked as in-network when it isn't, ask whether the company can fix the problem at intake or only rebill the claim.
Take this list of work to every sales call. Get a yes or no for each item, and the price if it costs extra.
- Eligibility and benefits checks at intake, before the first session
- Claim submission after each session
- Denial follow-up and appeals
- Patient statements and balance follow-up
- Credentialing for new clinicians, plus renewals
- Supervisory billing for pre-licensed clinicians
- Out-of-network claims and superbills
- A monthly accounts-receivable aging report
The fee basis changes what you pay
Two billing companies can quote similar percentages and send very different invoices, because they charge on different amounts. Some charge on the allowed amount, which is the insurer's payment plus what the client owes. Others charge on what's collected, and some charge per claim or a flat monthly fee.
With a fee on the allowed amount, the biller is paid the same whether or not the client pays their share. A fee on collections moves with the money you receive. A flat fee is predictable, but it doesn't shrink in a slow month. Our billing cost guide works through the numbers.
Mental health billing specialists
Mental health billing specialists take a claim from submission to payment, and most also check benefits and offer credentialing.
Choose this group when your front desk already collects accurate insurance details and you mainly need claims filed, denials worked and payments posted. Several of them quote group practices individually, so ask for group pricing in writing.
TheraThink
A Seattle billing service for licensed mental health professionals and groups. It charges 6.5% to 8% of the contracted rate or allowed amount, only on paid claims, plus its clearinghouse's $35 monthly fee per tax ID and rendering NPI. The fee covers eligibility checks within two business days, daily claims, denials, patient statements, appointment reminders and a portal with claim status. Credentialing costs extra, though it was advertising free credentialing as a limited-time promotion when we checked. It runs month-to-month with a free 30-day trial and quotes group rates. It fits a solo or small practice whose intake already runs well.
Psyquel
A San Antonio company that has served only behavioral health providers since 1997. Billing on its own costs from 6% of insurance collections, with no minimum monthly fee, and you keep your current EHR. With Psyquel's own EHR, full-service billing is priced per claim instead, at $1.87 per submission plus $3.98 per collection for 5 to 100 claims a month, and less at higher volume. It lists no contracts or setup fees. Full-service billing includes new-patient insurance verification, rejections, denials, appeals and EOB posting, with a dedicated billing specialist as your point of contact. It fits a practice that wants billing on its current EHR, or its EHR and billing from one company.
Psychiatric Billing Associates
A billing service for psychiatry and behavioral health groups nationwide. It charges a percentage of total collected revenue, quoted for each practice, and says optional add-on services are agreed beforehand. It calls insurers to verify benefits and authorization requirements, and the practice obtains any preauthorizations and referrals. Each practice gets a dedicated billing account manager, online claim status and a monthly financial report. Its FAQ says your in-house team can focus on patient care, front-desk operations and scheduling while it handles billing. It fits a group that wants a dedicated account manager and a fee tied to collections.
Resilience Billing
A mental health billing company founded by clinicians, with an in-house team in Woodstock, Illinois. It charges a percentage of net collections, quoted after a consultation, and nothing on claims that aren't paid. Before the first appointment, it checks benefits and prior authorization. It files claims and works denials weekly, posts payments, sends patient statements, handles credentialing and reports practice metrics. It works inside your EHR, most often TherapyNotes, and serves practices nationwide except New York and New Jersey. It fits a group practice that wants billing and credentialing from one in-house team.
Sawgrass Behavioral Resources
A behavioral health billing company founded in 2017, serving private practices and outpatient clinics. Its billing fee is 6% of total monthly collections, with minimum requirements, and onboarding starts at $99. It verifies benefits for new patients, monitors eligibility, files claims and follows up on accounts receivable, including patient responsibility. It also handles credentialing and payer enrollment. It bills from practice management software it provides, and you can keep your EHR. It fits a practice that wants credentialing and billing for one collections-based fee.
Flat-fee billing for solo and small practices
A flat monthly fee makes the billing invoice predictable, and these three companies publish theirs.
Flat fees suit a solo clinician or a small group with a steady insurance caseload. When collections are high, a flat fee can cost less than a percentage, but it stays the same in a slow month. Check what's excluded, how often claims go out and whether the company takes groups.
Cascade Therapy Billing
A billing company working only with mental health professionals. Solo clinicians pay a flat $500 a month for under an average of 15 clients a week. The fee is $750 for 16 to 20 clients and $1,000 for over 21. Group practices get a quote. It covers claims, follow-up, denials, appeals, payment posting, reporting and patient balance reminder calls. It fits a solo clinician with a steady weekly caseload.
The Bowerbirds
A back office for independent therapists at $999 a month, flat, with no percentage, no setup fee and no contract. It covers insurance claims, denials, copays and statements, eligibility checks before the first session, credentialing, intake forms, reminders, waitlist rebooking and a client portal. It serves a practice of one or a small group. Its home page doesn't list payroll. It fits a solo or small practice that wants billing and scheduling tools for one price.
SimpleBilling for SimplePractice
A boutique biller at $350 a month, flat, for psychotherapists who use SimplePractice. It submits claims every two weeks, works unpaid claims with insurers and sends a claim-status report every two weeks. It charges no startup fee and limits how many therapists it takes on. It fits a solo therapist on SimplePractice with a modest insurance caseload.
Billing through your EHR
Your EHR company may connect you with billing help, which keeps the claims inside the system your clinicians already use.
This route fits when you want one fewer system to manage. Ask who does the work, what it costs per claim or per month, and whether credentialing and patient balances are included.
TherapyNotes billing partners
TherapyNotes matches practices with partner billing companies that work inside TherapyNotes. Its team learns about your practice, then connects you with a partner suited to it. The partner company does the billing. TherapyNotes doesn't publish the partners' prices. It fits a TherapyNotes practice that wants a shortlist instead of searching alone.
SimplePractice
SimplePractice's pricing page lists Insurance Navigator, an add-on at $1.79 per claim after 30 days free. It includes a claim assistant that catches and corrects errors, automatic benefits checks with client cost estimates, and direct access to SimplePractice's Insurance Specialists. Your own team still does the billing, with expert help. SimplePractice's support article on managed billing requires a sign-in, so ask SimplePractice whether a managed service is offered on your plan.
Platforms that bill under their own arrangements
Alma and Grow Therapy do the insurance billing for clinicians who join them, under the platform's own insurance arrangements.
A platform and a billing company solve different problems. A platform like Alma or Grow gives a clinician access to its insurance contracts and rates, and it does the billing under them. A billing company works your practice's own contracts and bills in your practice's name. If you're a solo clinician without contracts, a platform can get you seeing insured clients quickly. If you're building a group, ask whose contracts your clinicians will bill under, what happens to those clients and rates if you leave, and whether your pre-licensed associates can join. A group that hires associates and wants its own brand usually needs its own contracts, and then a billing company or operations team to work them.
Our Headway and Alma guide covers how Headway works.
Alma
Alma credentials clinicians under Alma's tax ID, even those already credentialed with the same payers, and members bill eligible clients through the Alma portal at what Alma calls enhanced rates. Members pay a membership fee, listed at $95 a month on an annual plan, and Alma runs eligibility checks, claims and weekly or biweekly payouts. It doesn't take a cut of cash-pay visits. It fits a clinician who wants insurance access without holding contracts of their own.
Grow Therapy
Grow handles billing, claims, credentialing and payor enrollment for clinicians who join it as independent contractors, and pays providers per session each week. It says enrollment time depends on your state and the networks you join. It fits a licensed clinician who wants to see insured clients without running billing.
A full-service operations team
Cortexa
Cortexa publishes this guide. It runs the front desk, intake, billing, credentialing and payroll for independent therapy practices as one team. At intake it verifies eligibility and in-network status and gives out-of-network and self-pay clients a cost estimate. Billing covers claims, follow-up, appeals, supervisory and incident-to billing under your contracts, out-of-network claims, superbills, patient statements and a monthly aging report. Billing runs about 3% of what you collect, or about 6% with the front desk and intake. It fits a group whose billing problems start at intake. If you only need claims filed, a specialist above is simpler.
All options side by side
Prices are as each company publishes them. Confirm current terms in writing before you sign.
| Company | Best for | How it charges | Includes front desk/intake? |
|---|---|---|---|
| TheraThink | Claims help for solo practices and small groups | 6.5% to 8% of allowed amount, paid claims only | No. Offers reminders and a calendar |
| Psyquel | Billing on your EHR, or billing plus its own EHR | From 6% of insurance collections, or per claim with its EHR | Intake forms in its EHR |
| Psychiatric Billing Associates | A dedicated account manager and a collections-based fee | % of total collected revenue, quoted | No. Its FAQ leaves scheduling with your team |
| Resilience Billing | In-house billing and credentialing, outside NY and NJ | % of net collections, quoted after a consult | No. Checks benefits before the first visit |
| Sawgrass Behavioral Resources | Collections-based billing with credentialing | 6% of total monthly collections | No |
| Cascade Therapy Billing | Solo clinicians who want a flat fee | $500 to $1,000 a month for solos | No |
| The Bowerbirds | Solo or small group, billing plus scheduling | $999 a month, flat | Partly. Intake forms, reminders, waitlist |
| SimpleBilling for SimplePractice | Solo therapists on SimplePractice | $350 a month, flat | No |
| TherapyNotes billing partners | TherapyNotes practices | Not published | Not stated |
| SimplePractice Insurance Navigator | Doing your own billing with expert help | $1.79 per claim after 30 days free | No |
| Alma | Clinicians who want network access | Monthly membership fee | No |
| Grow Therapy | Licensed clinicians joining as contractors | Pays clinicians per session, rates vary | No. Lists you in its directory |
| Cortexa | Group practices that want one team | About 3% of collections for billing, 6% with front desk and intake | Yes. Phones, inquiries, intake and matching |
Common questions
What is the best billing company for a small group therapy practice?
It depends on where your problems start. If intake runs well and you need claims filed and denials worked, compare specialists such as TheraThink, Psyquel and Resilience Billing. Ask each for group pricing in writing. If you want a predictable bill, Cascade quotes groups and The Bowerbirds serves small groups for a flat fee. If denials begin at intake, compare options that also handle intake, such as The Bowerbirds for a solo or small practice, or Cortexa for a group that also bills for supervised clinicians.
How much does TheraThink cost?
TheraThink charges 6.5% to 8% of the contracted rate or allowed amount, only on paid claims. It adds $35 a month for each unique tax ID and rendering NPI in months when it submits claims, and drops that fee when it would be under 5% of your invoice. It has no startup fee and no per-claim submission fee, and it verifies eligibility and benefits for free. Credentialing costs extra, and its pages list three sets of prices, from $120 to $160 per commercial panel and $260 to $270 for Medicare or Medicaid. Groups of two or more providers are asked to request group rates.
Is it better to use Headway or a billing company?
They do different jobs. A platform bills under its own insurance arrangements, so you work with its contracts and rates. If you leave, you may need contracts of your own. A billing company works your practice's own contracts. A solo clinician without contracts may start faster on a platform. A group that hires associates and wants its own brand usually needs its own contracts. Our Headway and Alma guide covers the details.
How do I switch billing companies without losing claims?
Plan the handover before you give notice. List every claim that's submitted but unpaid, and agree in writing who follows each one to payment. Set a cutover date for new claims. Ask your old biller for a final accounts-receivable aging report. Check the notice period in your contract. Some billers, including TheraThink, offer to take only your new clients first, so you can compare the two side by side.