Most behavioral health practices searching for a billing company run into the same problem. The lists they find are written by companies that rank themselves first. That is not a comparison. It is a sales pitch with a title.
This page compares 8 outsourced behavioral health billing companies on factors that affect your collections: specialty depth, denial management, prior authorization handling, and transparency on cost. Software platforms such as TherapyNotes, Tebra, and AdvancedMD are not included here. They are tools your staff uses to manage claims, not companies that manage claims for you. If you need someone to run your revenue cycle rather than organize it, this list is for you.
Why Behavioral Health Billing Is Harder Than General Medical Billing
Several requirements apply specifically to behavioral health that general billing teams get wrong. The consequences are not minor. A missed prior authorization or a misapplied modifier on a psychotherapy code can produce the same denial across dozens of patients before anyone catches it.
- Time-based psychotherapy codes (90832, 90834, 90837) require the billed time to match the documentation exactly. A 50-minute session billed as 90837 with a 38-minute clinical note is a denial. The documentation has to support the code, not just describe the session.
- Behavioral health carve-outs mean many patients have their mental health benefits administered by a company separate from their main insurance plan. Verifying benefits, submitting claims, and appealing denials all go to different entities. Calling the wrong one delays everything.
- Prior authorization for behavioral health services is tracked separately from medical authorizations in most commercial plans. An authorization that expires before the date of service is an automatic denial, and catching it requires someone monitoring the schedule against active auths daily.
- 42 CFR Part 2 restricts how substance use disorder records can be shared, including with payers and other treating providers. Billing companies that work with SUD practices need to understand these restrictions or create compliance exposure.
- ABA billing runs on a unit-based model with payer-specific rules that differ significantly from fee-for-service therapy billing. What one payer requires for H2019 is not what another requires for the same service.
- Telehealth reimbursement for behavioral health varies by payer, service type, and place of service code. Medicare allows behavioral health telehealth at POS 10 (patient’s home) under specific conditions. Most commercial payers have their own rules, and several updated them within the last year.
A general medical billing company can learn these requirements. The question is whether they already have staff trained on them or whether your practice pays for the learning curve.
Outsourced RCM vs. Billing Software: Know What You Are Buying
Several comparison pages in this category mix software platforms with outsourced billing companies. They are different products that solve different problems.
Billing software gives your staff a tool to submit and track claims. Your team still does the work. Outsourced RCM means the billing company handles eligibility checks, claim submission, prior authorization follow-up, denial appeals, and AR recovery. Your staff handles clinical work. The billing company handles everything else.
All eight companies on this list provide outsourced billing services, not software subscriptions. If you want software, TherapyNotes, SimplePractice, and Valant are worth researching separately.
How We Ranked These Companies
No company paid for placement on this list. Each was evaluated on four things:
- Behavioral health specialization: Do their coders know psychotherapy CPT codes, carve-out handling, and prior authorization requirements specific to behavioral health payers?
- Denial management depth: How do they handle CO-4, CO-50, and CO-97 denials in behavioral health? Resubmission is not the same as appeals with documentation review.
- Credentialing support: Is it included in the quoted rate or billed as an add-on?
- Public reviews and pricing transparency: Third-party reviews from G2, Capterra, GoodFirms, or Clutch, and willingness to discuss pricing and performance metrics upfront.
8 Best Behavioral Health Billing Companies in 2026
1. BillingParadise — Best for Multi-Specialty Groups That Include Behavioral Health
BillingParadise has been in medical billing for over 15 years with a dedicated behavioral health team handling time-based psychotherapy coding, credentialing, prior authorization follow-up, denial management, and AR recovery. They work with solo providers and regional health networks.
They do not publish pricing. Rates are percentage-based and quoted per engagement. Reviews on Clutch and Yelp are consistently positive, with clients noting strong communication and low denial rates.
Best for: Practices billing across multiple specialties that want one billing partner for all of them.
Watch for: Better fit for practices submitting 300 or more claims per month. Solo therapists may find the service structure heavier than they need.
2. AnnexMed — Best for Therapy Groups That Want a Behavioral-Health-Only Billing Partner
AnnexMed focuses exclusively on mental health and behavioral health RCM. They report 95% clean claim rates and a 20-30% reduction in AR within 90 days for new clients. Coders are trained specifically on psychotherapy CPT codes, and credentialing comes standard.
Their client reviews consistently mention responsive account management. For a practice that needs someone to answer when a claim sits in payer review for 30 days, that matters more than it sounds.
Best for: Therapy groups and psychiatric practices where behavioral health is the only specialty being billed.
Watch for: If your practice also bills for general medical services, AnnexMed’s narrow focus can be a limitation. A multi-specialty billing company will handle the full picture.
3. Aayur Solutions — Best for Denial Management and Prior Authorization Follow-Through
Aayur Solutions is a revenue cycle management company with 17 years of RCM experience across denial-heavy specialties, including behavioral health, DME, and pain management. The team handles eligibility verification, coding, prior authorization tracking, claim submission, denial appeals, and AR follow-up as a full service.
The difference from a standard billing company shows in how denials are handled. A claim that comes back with a CO-50 (not medically necessary) denial in behavioral health is almost always a documentation problem. Aayur’s process involves reviewing the clinical documentation against the payer’s coverage criteria before resubmitting, not just resubmitting the same claim and hoping. CO-97 denials (payment adjusted because benefit for this service is included in another service already adjudicated) and behavioral health carve-out denials follow the same approach: identify the root cause, correct it, then appeal with supporting documentation.
Prior authorization tracking is built into the workflow, not bolted on. Authorizations are matched against the patient schedule before each date of service so expired or missing auths are caught before the claim is even generated.
Aayur serves behavioral health practices, psychiatric groups, and integrated care settings across all 50 states. The team operates remotely and works with practices of most sizes.
Services include: Eligibility and benefits verification, prior authorization management, claim submission and scrubbing, denial management and structured appeals, AR recovery, and credentialing support.
Best for: Practices with high denial rates, prior authorization backlogs, or AR that keeps aging past 90 days despite resubmissions.
Watch for: Aayur is a better fit for practices that want a full RCM partner than for those looking only for claim submission with no follow-up.
Learn more: Behavioral Health Billing Guide | Request a Free Billing Audit
4. Plutus Health — Best for Larger Behavioral Health Organizations
Plutus Health has 15 years in healthcare RCM and a dedicated behavioral health billing team covering psychiatry, therapy, ABA, and SUD services. They handle prior authorization, denial management, credentialing, coding compliance, and revenue reporting for medium to large practices and hospital-based psychiatric programs.
Client reviews note strong denial recovery rates and detailed monthly reporting. The reporting depth appeals to organizations that need billing data tied to financial planning and board reporting, not just claim status updates.
Best for: Hospital-based psychiatric units and multi-location behavioral health organizations billing at significant volume.
Watch for: Pricing is not published and is negotiated per contract. Get a full breakdown of what is included before comparing their rate to other companies.
5. 247 Medical Billing Services — Best for High-Volume Practices That Want Published Benchmarks
247 Medical Billing Services is one of the larger outsourced billing companies in the US. They publish performance benchmarks, have dedicated teams for denial management and credentialing, and cover behavioral health billing for psychiatry, therapy, ABA, and substance use disorder services.
The structured processes and reporting make them a reasonable choice for practices that want visibility into claim status and AR aging without chasing their billing team for updates.
Best for: High-volume practices that want an operation with documented processes and measurable benchmarks.
Watch for: The size that makes them reliable also reduces personalization. Ask how client accounts are staffed before signing. Some practices find they are working with a rotating team rather than a dedicated manager.
6. BehavioralProz — Best for Practices With a Carve-Out-Heavy Payer Mix
BehavioralProz works exclusively with behavioral health, ABA, and substance use disorder practices. The narrow focus means their billing staff already knows psychotherapy CPT codes, ABA unit billing, 42 CFR Part 2 compliance requirements, and carve-out payer handling without needing specialty-specific training.
One client reported a 28% revenue increase within six months of switching from a general billing company. Third-party review coverage is limited compared to larger companies, so ask for references from practices in your specific specialty before committing.
Best for: Practices whose payer mix is mostly behavioral health carve-outs and state Medicaid programs, where specialty coding accuracy matters most.
Watch for: If behavioral health is one service line among several in your practice, the narrow focus may be a constraint.
7. MediBillMD — Best for Multi-Specialty Practices That Include Behavioral Health
MediBillMD offers billing services across multiple specialties with a behavioral health line covering claim submission, denial management, credentialing, and reporting. Reviews on GoodFirms and Trustpilot average 4.0 out of 5 across 52 reviews, with clients noting consistent AR follow-up and reliable communication.
Best for: Multi-specialty group practices that want one billing company for several specialty lines, with behavioral health as one of them.
Watch for: If behavioral health is your primary or only specialty, a behavioral-health-focused company will produce better coding accuracy on the specialty-specific codes that general billing teams miss most often.
8. Practolytics — Best for Practices That Want RCM Services With a Technology Layer
Practolytics has been in healthcare RCM for over 20 years and combines billing services with practice management technology. Their model is different from pure-play billing companies because the technology component adds operational tools alongside the billing service. Pricing runs on a percentage-of-collections model.
Best for: Practices that want billing services bundled with operational tools rather than a standalone outsourced billing arrangement.
Watch for: If you are looking strictly for outsourced billing without a technology layer, another company on this list will be a cleaner fit. The technology component adds cost that purely service-oriented companies do not carry.
Quick Comparison
| Company | BH Specialty Focus | Credentialing | Prior Auth Tracking | Best For |
|---|---|---|---|---|
| BillingParadise | Strong | Yes | Yes | Multi-specialty groups |
| AnnexMed | BH-only | Yes | Yes | Therapy and psychiatric practices |
| Aayur Solutions | Strong | Yes | Yes | Denial management, mid-size practices |
| Plutus Health | Strong | Yes | Yes | Hospital-based psychiatric programs |
| 247 Medical Billing | Strong | Yes | Yes | High-volume practices |
| BehavioralProz | BH-only | Yes | Yes | Carve-out heavy payer mixes |
| MediBillMD | Moderate | Yes | Yes | Multi-specialty groups |
| Practolytics | Moderate | Yes | Yes | RCM plus technology buyers |
Questions to Ask Before You Sign
Use these when you are speaking with any company on this list. Vague answers to any of them are a warning sign.
- Do you have coders who specialize in behavioral health, or is behavioral health one track among many specialties your team covers?
- How do you handle behavioral health carve-out plans? Walk me through how you verify benefits and submit claims when the mental health benefits are administered separately from the medical plan.
- What is your current first-pass claim rate for behavioral health clients, and how do you calculate it?
- How do you handle CO-50 denials in behavioral health? Specifically, what happens between the denial arriving and the appeal being submitted?
- Is credentialing included in your quoted rate or billed separately?
- If we bill for substance use disorder services, do you have staff trained on 42 CFR Part 2 requirements?
- Who is my primary contact when a claim has been in payer review for 30 days and I need someone to follow up?
Frequently Asked Questions
What does outsourced behavioral health billing typically cost?
Most outsourced behavioral health billing companies charge between 4% and 8% of collected revenue. The rate depends on practice size, claim volume, specialty mix, and whether credentialing and prior authorization management are included in the base rate. Get a written breakdown of exactly what is included before comparing quotes from different companies.
Why do behavioral health claims get denied more than general medical claims?
Three factors produce most of the difference. First, time-based psychotherapy codes require the billed time to match the clinical documentation precisely. Second, prior authorization for behavioral health often runs through a carve-out plan that requires separate verification from the main medical plan. Third, telehealth place-of-service codes for behavioral health vary by payer and are updated more frequently than most payers communicate clearly. Any one of these produces denials that a general billing team without behavioral health experience may not recognize or know how to appeal correctly.
What CPT codes are used most often in behavioral health billing?
The most frequently billed psychotherapy codes are 90832 (30 minutes), 90834 (45 minutes), 90837 (60 minutes), 90847 (family therapy with patient present), and 90853 (group therapy). Psychiatric evaluation uses 90792. Medication management for established patients most often uses 99213 and 99214. ABA services use codes in the 97151 through 97158 range, with units and authorization requirements varying by payer.
What is a behavioral health carve-out and why does it complicate billing?
A carve-out is a health plan structure where behavioral health benefits are administered by a company separate from the patient’s main insurance. The medical plan covers physical health claims. A different company, called a behavioral health organization (BHO), handles mental health and SUD claims. For billing, this means verifying benefits, submitting claims, and appealing denials all go to different entities with different processes. A billing team that calls the main insurer to verify behavioral health auth is calling the wrong company.
How quickly should a practice see results after outsourcing behavioral health billing?
Claim accuracy typically improves within 30 days as the billing company’s coders take over submission. AR reduction shows in 60 to 90 days, which reflects the time for previously submitted claims to complete adjudication. New provider credentialing takes 90 to 120 days depending on the payer, which is the main reason practices should start the credentialing process before a provider’s first date of service.
What is 42 CFR Part 2 and why does it matter for SUD billing?
42 CFR Part 2 is a federal regulation that restricts how substance use disorder records can be disclosed. For billing purposes, it limits what information can be shared with payers and other providers without a specific patient authorization. The regulations were updated in 2024 to align more closely with HIPAA, but they still require patient consent before certain disclosures that would be routine in other specialties. A billing company without SUD billing experience may not know when consent is required or how to structure the billing process to stay compliant.
Can behavioral health billing companies handle telehealth claims?
Yes, but telehealth billing for behavioral health requires payer-specific knowledge. Medicare covers behavioral health telehealth at POS 10 (patient’s home) under specific clinical and documentation conditions. Most commercial payers have their own modifier requirements (95 for real-time interactive audiovisual, GT for Medicare advantage plans) and their own limitations on which services qualify. A billing company handling behavioral health telehealth should be able to confirm the specific requirements for each payer in your mix before submitting a single claim.
Behavioral health practices lose more revenue to billing errors than most other specialties because the documentation requirements are stricter and the payer rules are less consistent. If your current billing setup is producing denials you cannot explain or AR that keeps aging past 90 days despite resubmissions, a billing audit is the fastest way to find out where the problem starts. Aayur Solutions offers a free billing audit for behavioral health practices. Contact us to get started.
Written by
Ajay Pillai CEO & Founder, Aayur Solutions LLCAjay Pillai is the CEO of Aayur Solutions LLC, a U.S.-based medical billing and revenue cycle management company serving DME/HME providers, dental practices, pain management clinics, and specialty care organizations. With 17+ years of hands-on RCM experience, he has led billing operations, denial management workflows, and prior authorization programs for healthcare providers across the United States. Ajay holds credentials from the Indian Institute of Management and Case Western Reserve University, and is based in Sheridan, Wyoming. He holds a management qualification from IIM Calcutta and a certificate from Case Western Reserve University's health management programme.
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