Active coverage for date of service

In-network vs out-of-network status

Behavioral health benefits + visit limits

Copay, deductible, coinsurance position

Prior auth / notification requirements

Telehealth coverage rules (when applicable)

Psychotherapy: 90832 / 90834 / 90837

Crisis psychotherapy: 90839 / 90840

Group therapy: 90853

Diagnostic evaluation: 90791

ICD-10 diagnosis alignment supported by assessment + plan

Medicare rules based on LCSW enrollment + allowed services

Medicaid requirements based on state behavioral health rules

Commercial payer setup with correct rendering/billing structure

Out-of-network submission workflows when not contracted

Correct identifiers, taxonomy alignment, and required claim fields

ERA/EOB posting with accuracy checks

Correct adjustments to prevent hidden write-offs

Underpayment identification when rates or policies weren’t applied

Reconciliation that turns remittance into actions

Aging segmentation by payer and priority

Follow-up cadence matched to payer timelines

Escalation for stalled claims

Recovery actions for documentation, enrollment, or payer issues

Eligibility / carve-out routing errors

Missing authorization

Coding/documentation mismatches

Telehealth configuration mistakes

Policy exclusions and payer setup issues

Appeals when the claim is supportable + prevention controls