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.
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.
"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
Claim investigations, denial analysis, payment recovery efforts, and insurer internal appeal submissions. Services are limited to carrier-level internal appeals (Levels 1 and 2).
- Claim investigation and denial root-cause analysis
- Level 1 & 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
- Written outcome reports with recovered amounts
Behavioral Health Billing Support
Targeted consulting on specific billing issues. 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
- Payer-specific behavioral health billing requirement guidance
Denial Pattern Analysis
A one-time, fixed-scope diagnostic engagement identifying root causes of your denials and surfacing recoverable revenue in your aged claims.
- 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
- Fixed flat fee by practice size — no surprise charges
Out-of-Network Billing & Single Case Agreement Negotiation
We handle OON reimbursement work and negotiate Single Case Agreements directly with commercial payers on your behalf.
- 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
Behavioral Health Client Intake Specialist
A non-clinical conversation for patients, families, and individuals who need help understanding their behavioral health options and navigating insurance — without diagnosis, treatment, or therapy.
- Quick Clarity Session (15 min) — Focused answers to specific administrative questions
- Foundational Navigation Session (30 min) — Overview of options, basic insurance review, primary provider matching
- Comprehensive Roadmap (45 min) — Personalized roadmap, call guides, detailed benefits review
- Deep Dive & Support Session (60 min) — Complex cases, multi-diagnostic situations, family groups
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
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.
Direct Expert Access
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.
PA & NJ Payer Expertise
HealthChoices BH-MCOs, NJ FamilyCare, IBX, Horizon, and all the regional nuances that national firms miss.
Remote & Fully Flexible
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.
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.
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. 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. Most practices never use this powerful tool.
Read Full Article →Modifier 95 vs. Modifier 93: Getting Telehealth Billing Right in 2026
Modifier 95 covers live video sessions, while Modifier 93 is required for audio-only. Using the wrong modifier 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.
Read Full Article →Solo Therapist's Guide to Insurance Billing: What to Do When Payers Push Back
The most common denial types for independent therapists are entirely predictable, and most have clear, straightforward responses.
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.
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.
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 — mandatory MFA, encryption, vulnerability scanning, and more.
Read Full Article →Answers to your most common questions.
Transparency matters to us. If you have a question not covered here, reach out directly.
Our claims recovery service is billed on a pure contingency basis — you only pay when we successfully recover funds. Our fee is a percentage of the net amount actually recovered and paid to your practice, agreed upon in writing before we begin.
CPMM prepares all Level 1 and Level 2 internal appeal documentation, letters, and resubmission strategies — coordinated through your existing billing software or billing staff. We do not need direct access to your practice management system, and your PHI stays within your existing secure environment.
We work with behavioral health and mental health providers of all sizes — solo practitioners (LCSWs, LPCs, LMFTs, psychologists, psychiatrists, PMHNPs), small and mid-size group practices, community mental health centers, treatment centers, and substance use programs.
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.
No. Every engagement is project-based. We earn your continued business through results — not by locking you into a contract.
A Single Case Agreement (SCA) is a one-time contract between your practice and a commercial payer allowing reimbursement at an agreed rate for a specific out-of-network patient. We negotiate directly with the payer to secure a case-by-case in-network equivalent rate.
Yes — we are open to working with practices in other states. Claims recovery, Denial Pattern Analysis, and OON/SCA work are largely portable across state lines. Reach out and we will tell you honestly whether we can help.
Ready to recover behavioral health revenue your practice has already earned?
Start with a claims review. Tell us what you are dealing with — we will tell you honestly what we think is recoverable.