Generated from prompt:
Create a 20-slide billing and admin training presentation for outpatient therapy (LCSW) for Peace of Mind Mental Health Group. Include detailed how-to instructions and realistic platform screenshots. Cover: 1. Overview of outpatient therapy billing workflow 2. Patient intake and insurance verification - Availity portal steps - NaviNet verification steps - Explanation of Promise ID - MCO overview and PerformCare specifics 3. TheraNest/Ensora walkthrough - Adding clients - Creating and submitting claims - Posting payments - Managing telehealth sessions 4. Telehealth billing rules and modifiers 5. Common denials and troubleshooting 6. Compliance and best practices The design should be professional and branded with Peace of Mind Mental Health Group’s logo and colors (green tones). Use clear visuals and callouts for each step, and include placeholder mock screenshots that resemble Availity, NaviNet, and TheraNest interfaces.
20-slide professional training for Peace of Mind Mental Health Group covers billing workflow, insurance verification (Availity/NaviNet/Promise ID/PerformCare), TheraNest how-tos (clients/claims/paymen
This title slide welcomes participants to Billing & Admin Training. The subtitle specifies Outpatient Therapy (LCSW) Billing Workflow & Best Practices.
Outpatient Therapy (LCSW) Billing Workflow & Best Practices.
Source: Peace of Mind Mental Health Group logo in green tones.
This agenda slide outlines a presentation on outpatient therapy billing workflows. It covers billing overview, patient intake/verification, TheraNest/Ensora walkthrough, telehealth rules, and denials/compliance best practices.
High-level overview of outpatient therapy billing process.
Availity, NaviNet steps, Promise ID, and MCO overview.
Adding clients, claims, payments, and telehealth management.
Specific modifiers and guidelines for telehealth claims.
Troubleshooting denials and essential compliance tips. Source: Peace of Mind Mental Health Group Billing Training
This section header slide from the Peace of Mind Mental Health Group Billing & Admin Training introduces Section 1. It overviews the outpatient therapy billing workflow, outlining the high-level process from intake to payment posting for LCSW services.
1
High-level process from intake to payment posting for LCSW services.
The "Workflow Visual Aid" slide visually outlines a four-stage process for client management in TheraNest. Key steps include Intake and Insurance Verification, Client Setup in TheraNest, Service Delivery and Claims, and Payments, Denials, Compliance.
Source: Photo by Cole Johnson on Unsplash
This section header slide from "Peace of Mind Mental Health Group" introduces Section 2: Patient Intake & Insurance Verification. The subtitle emphasizes step-by-step eligibility checks using portals.
2
Step-by-step eligibility checks using portals
Source: Billing and Admin Training Presentation
The Availity Portal Steps slide outlines four key actions for checking member eligibility. Log in to Availity.com, search by member ID or name, verify coverage/copay/auth requirements, and screenshot the full eligibility response.
Source: placeholderavailityscreenshot_green.png
This slide shows a mock Availity screenshot for entering patient details in the top search bar and reviewing eligibility results in the table below. It highlights key coverage and policy details, including copays, deductibles, and active dates.
Source: Availity Portal Mockup
The "NaviNet Verification Steps" slide outlines a four-step process for eligibility checks. It includes accessing NaviNet via the Aetna member portal, entering patient demographics, reviewing benefits and authorizations, and exporting a PDF verification report.
Source: Aetna NaviNet Portal
The slide displays a mock NaviNet screenshot highlighting key search and verification steps. Users should enter a Promise ID or member details in the search bar, review the Benefits Summary for coverage and eligibility, and verify Authorization Status for therapy services.
Source: NaviNet Provider Portal
The Promise ID is a unique NJ Medicaid identifier for mental health services that verifies patient eligibility for MH billing and claims while linking them to a specific MCO plan. Obtain it via Availity or NaviNet verification, as it is essential for accurate reimbursement.
Source: Peace of Mind Mental Health Group Training
MCOs like Horizon NJ Health manage Medicaid behavioral health benefits, overseeing care coordination, authorizations, claims processing, and require eligibility verification via Availity/NaviNet before scheduling. PerformCare is New Jersey's managed BH network for Medicaid, serving as the central hub for prior authorizations, provider enrollment, care management, and outpatient therapy auth requests.
| Managed Care Organizations (MCOs) | PerformCare |
|---|---|
| MCOs like Horizon NJ Health manage Medicaid behavioral health benefits. They oversee care coordination, service authorizations, and claims processing. Always verify eligibility via Availity/NaviNet portals before scheduling. | PerformCare is NJ's managed BH network for Medicaid. Central hub for prior authorizations, provider enrollment, and care management. Submit auth requests here for outpatient therapy services. |
Source: Peace of Mind Mental Health Group
This section header slide for Peace of Mind Mental Health Group introduces Section 3: TheraNest/Ensora Walkthrough. Its subtitle focuses on key admin tasks in practice management software.
3
Key admin tasks in practice management software.
Source: TheraNest/Ensora
The slide "Adding Clients" outlines navigating to the Client tab, selecting New Client, and entering demographics, insurance details, and Promise ID. It then instructs assigning an LCSW as the primary provider, saving, and verifying the new client profile.
Source: TheraNest/Ensora Walkthrough
This slide illustrates adding a new client in TheraNest by navigating to the Clients menu and selecting Add Client. It highlights entering demographics (name, DOB, address, phone), adding insurance details (policy ID, group number, Promise ID), reviewing the form, and clicking Save.
Source: Mock TheraNest interface screenshot
The slide "Creating & Submitting Claims" provides a step-by-step guide for billing. It covers navigating to Billing → New Claim, selecting CPT 90837 with modifiers, entering patient and service details, reviewing for accuracy, and submitting electronically via the portal.
Source: TheraNest
The "Mock Claims Submission" slide demonstrates the steps for submitting a claim form. It includes entering patient and insurance details, selecting CPT codes (e.g., 90834, 90837), adding accurate ICD-10 diagnosis codes, reviewing the form, and clicking Submit.
Source: TheraNest Mockup
This slide outlines posting payments from EOBs to patient claims, reconciling the ledger, and applying adjustments for denials or balances. It also covers logging telehealth sessions with the GT modifier and verifying billing compliance rules.
This section header slide from the "Peace of Mind Mental Health Group" presentation introduces Section 4: "Telehealth Billing Rules." The subtitle focuses on "Modifiers & compliance for virtual LCSW sessions."
4
Modifiers & compliance for virtual LCSW sessions
Source: Billing & Admin Training: Outpatient Therapy (LCSW)
The Telehealth Modifiers Table lists CPT codes for mental health services, each paired with modifiers 95 and GT. It covers 90832 (30min psychotherapy), 90834 (45min therapy), 90837 (60min therapy), and 90791 (diagnostic evaluation).
{ "headers": [ "CPT", "Modifier", "Use" ], "rows": [ [ "90832", "95, GT", "30min psychotherapy" ], [ "90834", "95, GT", "45min therapy" ], [ "90837", "95, GT", "60min therapy" ], [ "90791", "95, GT", "Diagnostic evaluation" ] ] }
Source: Peace of Mind Mental Health Group Billing Guide
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