Mental Health Claim Submission Process: Steps for Therapists and Psychiatrists

The mental health claim submission process is the path a claim takes from the front desk to a payment posted in your books. It has about nine steps, and most denials start at step one or two, not at the end. Here is how it works for therapists and psychiatrists, and what to do on Monday morning.

What is the mental health claim submission process?

It is the set of steps that turns a finished session into a paid claim. You confirm coverage, build the claim, send it through a Clearinghouse, read the payer’s acknowledgements, and post the payment. If anything fails, you fix it and resubmit. Each step leaves a record, so you can see exactly where a claim stalled.

Step 1: Check eligibility and benefits first

Eligibility Verification confirms the client’s coverage is active and shows the behavioral health benefits before you bill. Check it before the first visit and again when coverage may have changed. Note the member ID, the plan type, copay or coinsurance, and whether the payer wants prior authorization for the service.

Step 2: Build a clean claim

Building the claim is the heart of the mental health claim submission process. A claim is the bill for one client and one set of dates of service. Paper practices use the CMS-1500 form maintained by the National Uniform Claim Committee (NUCC). Electronic claims use the 837P, the standard electronic version of the professional claim. CMS says the paper form and the 837P carry matching data: diagnosis codes, procedure codes, modifiers, place of service and dates of service.

Use your NPI (National Provider Identifier) and the right Taxonomy Code for your license type. Match the diagnosis to the service. Look up codes in our CPT and E/M code guide before you bill.

A short note for psychiatrists

Prescribers usually bill an evaluation and management (E/M) visit. When a medication visit also includes psychotherapy, many payers expect a separate psychotherapy add-on code billed alongside the E/M code. The time, the documentation and the modifiers must support each service separately. Check each payer’s rules before you pair them.

Step 3: Send it through a clearinghouse

A clearinghouse is a middle service that checks your claim for errors and routes it to the right payer. You pick the payer by its payer ID, a number that tells the clearinghouse where to send the file. A wrong payer ID is a common reason claims vanish. Verify the ID on the payer’s own provider page, and cross-check it in our insurance companies contact directory.

Step 4: Read the acknowledgements

An acknowledgement tells you whether a payer or clearinghouse received your file. Two matter most. The 999 reports on file structure. The 277CA reports whether each claim was accepted for processing. CMS describes the 999 and 277CA as the reports that confirm syntax and claim status. Work any rejection the same day. A rejected claim never reached adjudication, so the filing clock keeps running.

Step 5: Post the payment from the ERA or 835

The electronic remittance advice (ERA) is the payer’s electronic payment explanation. It uses the X12 835 transaction set, which can carry payment, an Explanation of Benefits, or both. Medicare remittances use the 835 format as well. Read the adjustment and remark codes line by line. Do not post a payment until you know why any amount was reduced.

Step 6: Work denials and send a corrected claim

A denial is a payer decision not to pay. Read the reason first. If the claim had a data error, send a Corrected Claim that follows the payer’s instructions. If the payer disagreed with medical or coverage facts, appeal instead. See our guide to appeals for Georgia therapists for one example of a state-specific path.

Step 7: Bill the secondary payer

The last stage of the mental health claim submission process is the secondary claim. When a client has two plans, the first payer’s ERA drives the second claim. Send the secondary claim only after the primary pays or denies. Attach or transmit the primary payment details as the secondary payer requires.

Private payers, Medicare and Medicaid differ

Private payers

Each commercial plan sets its own payer ID, filing window and corrected-claim rules. Never assume one plan works like another. See our private insurance guides.

Medicare

For Medicare, CMS says initial claims must be filed electronically unless an exception or waiver applies. Claims must reach the Medicare contractor within one calendar year of the date of service. Read our Medicare timely filing guide for therapists.

Medicaid

Medicaid is run by each state. Rules, forms and portals differ by state, so use your state agency’s provider manual, not another state’s.

What to do Monday morning

• Walk your mental health claim submission process from the oldest unpaid claim forward.
• Check the 999 and 277CA reports for rejections and fix them today.
• Post new ERAs and flag every denial with its reason.
• Confirm coverage for this week’s new clients.
• Check your payer ID list against each payer’s provider page.

The short version: mental health claim submission process

Verify coverage, build a clean claim, send it through a clearinghouse, read the acknowledgements, post the ERA, and work every denial. Do it the same way each week. A steady mental health claim submission process finds problems while you can still fix them.

How MCM South helps

MCM South Medical Billing Service exclusively serves psychotherapists and psychiatrists in solo and medium-size practices. We run this process for clients, including out-of-network claims. If you want to hand it off, request a quote.

Sources checked (November 4, 2026)

• NUCC: 1500 Claim Form
• CMS: Medicare Billing, CMS-1500 and 837P (MLN006976)
• CMS transmittal on 999 and 277CA acknowledgements
• CMS: Health Care Payment and Remittance Advice
• X12: 835 Health Care Claim Payment/Advice

Next, see the Resources hub and our Who We Serve page.

Frequently asked questions

Where MCM South works

MCM South works only in mental and behavioral health. We serve psychotherapists and psychiatrists in solo and medium-size practices across ten currently served states: Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois. Need a payer contact? Use our insurance companies contact directory.