"Your time belongs in the chair, not in the insurance portals."
8 Questions to Ask Before Signing with Any Billing Vendor (And How Stelleo Delivers)
Choosing a billing partner is a major decision for your practice. To help you make an informed choice, we’ve answered the eight most critical questions you should ask any billing vendor before signing a contract.
1. What percentage of your clients are behavioral health practices?
At Stelleo: 100%. We specialize exclusively in behavioral health. Unlike general medical billers who handle everything from chiropractors to podiatrists, our entire focus, training, and expertise are dedicated solely to mental and behavioral health practices.
2. Explain what a behavioral health carve-out is and how you identify it at eligibility verification.
The Stelleo Approach: A carve-out occurs when an insurance company separates mental health benefits from physical health benefits, often outsourcing them to a different third-party administrator (like Magellan or Optum). We identify this during our rigorous eligibility verification process by checking the specific behavioral health benefit routing information, ensuring your claims are sent to the correct payer from day one to avoid instant rejections.
3. What is your average net collection rate for behavioral health clients?
Our Track Record: 97%. We pride ourselves on clean claim submission and aggressive follow-up, ensuring your practice recovers almost every single dollar it is rightfully owed.
4. How do you manage concurrent authorization renewals for IOP and PHP programs?
Our Focus: Our primary expertise is dedicated to outpatient therapy practices. By narrowing our focus strictly to outpatient care, the team at Stelleo is able to master the specific coding, modifiers, and daily billing nuances unique to outpatient therapists, psychologists, and counselors.
5. Describe your denial appeal process — do you use MHPAEA arguments?
How Stelleo Fights Denials: When a claim is unfairly denied, we don't just accept it. We review the denial immediately for coding errors or medical necessity issues. Where applicable, we leverage arguments rooted in the Mental Health Parity and Addiction Equity Act (MHPAEA) to ensure insurance companies are not placing stricter limitations on your mental health services than they do on standard medical care.
6. What billing software and clearinghouse do you use, and does it integrate with my EHR?
Our Tech Stack: Stelleo Billing Solutions is a proud affiliate of SimplePractice™ and we utilize Availity as our primary clearinghouse. This ensures seamless, top-tier integration with your system, allowing for secure, lightning-fast digital claim submissions and automated tracking.
7. What reports do you provide, and at what frequency?
Transparency at Stelleo: Complete transparency is our policy. You get daily updates via our custom "System Tracker," which you can securely access at any time. In addition to this real-time data, we offer customized weekly, bi-weekly, or monthly updates based entirely on your practice’s preference and needs.
8. What are your contract terms, and what happens to my AR if I leave?
The Stelleo Promise: We believe in earning your business every single month, so we do not lock you into long-term contracts. Either party can terminate services at any time with a simple 30-day written notice. Upon termination, all outstanding service fees become immediately due. Once settled, we cleanly transfer all provider access, portals, and data back to you, and any matching data in our possession is permanently and securely deleted for your peace of mind.
The Behavioral Health Enrollment Timeline: What to Expect
Navigating the back end of insurance setups requires patience. Because government and commercial payers move at their own pace, we use this timeline to track your milestones and keep your practice launch on schedule.
Phase 1: Credentialing & CAQH Setup
Timeline: 45 to 90 Days
What’s happening: Your professional history, license, and malpractice insurance are submitted and primary-source verified by the payers.
Stelleo Tip: A single typo on your CAQH profile can restart this clock. We audit your data before submission to prevent delays.
Phase 2: Contracting & Fee Schedules
Timeline: 30 to 60 Days (Starts after Phase 1 approval)
What’s happening: The insurance network issues your official participation agreement, assigns your effective date, and releases your reimbursement rates.
Phase 3: EDI, ERA, & EFT Enrollments
Timeline: 2 to 4 Weeks
What’s happening: Your software is linked to the clearinghouse (EDI), your digital remittance auto-postings are activated (ERA), and your direct deposits are linked to your bank (EFT).
How Urgent? Critical. You cannot submit clean, digital claims until this final phase is fully greenlit by the payers.
The Road to Your First Payout: A Step-by-Step Roadmap
Passing your licensing exam is an incredible milestone—but it’s just the beginning of your business journey. Transitioning from a newly licensed clinician to a private practice owner running a smooth billing cycle requires checking very specific boxes.
Here is the exact, step-by-step roadmap from passing your test to getting your first insurance payment.
Step 1: Legal & Business Foundation
Before you can apply to panels, you must exist as a legal business entity.
Form your business: Register your practice name (usually an LLC or PLLC) with your state.
Get an EIN: Apply for an Employer Identification Number (EIN) for free directly from the IRS website.
Open a Business Bank Account: Never mix personal and business finances. You will need this account for your EFT setups.
Secure Malpractice Insurance: Obtain a professional liability policy that lists your new business entity.
Step 2: The Core Provider Identifiers
Insurance companies identify you and your business using specific national numbers.
Type 1 NPI (Individual): You likely already have this, but you must log into the NPPES registry and update your taxonomy code to reflect your new independent license status and business address.
Type 2 NPI (Group/Organizational): Crucial if you incorporated as an LLC/PLLC. You must apply for an organizational NPI so insurance companies can distinguish between you as the clinician and your business as the billing entity.
Step 3: Setting Up CAQH & Availity Essentials
Think of CAQH as the "universal background check" system for healthcare. If this isn't pristine, everything else stops.
Build Your CAQH Profile: Upload your new license, malpractice face sheet, degree, CV (with no gaps in employment history), and business W-9.
Set to "Public": Ensure your profile permissions allow insurance companies to see your data.
Create an Availity Basic Account: Availity acts as the multi-payer hub. Register your new business entity here early so your tax ID and NPI are recognized in their system.
Step 4: The Credentialing Phase (The Waiting Game)
Now you are ready to request participation with insurance panels (e.g., Aetna, BCBS, Optum).
Submit Letters of Interest: Apply to your chosen panels through their provider portals, linking your applications to your CAQH ID.
Primary Source Verification: The insurance companies verify your background. This phase takes 45 to 90 days.
Step 5: The Contracting Phase & Fee Schedules
Once approved by the credentialing committee, you move to the legal department.
Review the Contract: The insurance company issues a participation agreement.
Analyze the Fee Schedule: Review the allowed amounts for your core CPT codes (like 90837 for a 60-minute session).
Sign and Establish Your Effective Date: Sign the contract. Note: You cannot bill for any clients seen before your official effective date.
Step 6: Setting Up Tech & Portals
With active contracts in hand, you must build the digital pipeline to get paid.
Establish Provider Portals: Create admin accounts on specific payer portals (like NaviNet or Optum Provider Express) to run manual eligibility checks.
Select and Configure Your EHR: Set up a system like SimplePractice™ with your new business details, NPIs, and client templates.
Step 7: The Final Enrollments (EDI, ERA, EFT)
This is the plumbing that connects your EHR to your bank account.
EDI Enrollment: Route your EHR through your clearinghouse (like Availity) to allow instant electronic claim submission.
ERA Enrollment: Turn on digital remittance so your EOBs post automatically to your software.
EFT Enrollment: Securely link your business checking account to each payer so funds are direct-deposited.
Step 8: The Grand Finale – First Claim Submission & Payout
Verify Eligibility: Before the first session, verify the client's mental health benefits, copay, and deductibles via your portals.
Conduct the Intake & Code the Session: Complete your documentation and attach the correct CPT code.
Submit the Claim: Send the claim electronically via your EHR.
Track & Post: The claim routes through the clearinghouse, clears payer scrubbing, and results in an automatic deposit into your bank account (EFT) alongside a matching digital receipt (ERA).
Behavioral Health Billing & Credentialing FAQs
Q: What is Credentialing?
What it is: The process of verifying your professional background (license, NPI, education, malpractice insurance, and CAQH profile) to prove to an insurance company that you meet their provider standards.
Why it matters: This is the essential first step. You cannot see insurance clients or submit claims as an in-network provider until the payer verifies your credentials.
Q: What is Contracting?
What it is: The official agreement process that happens after you are credentialed. This is where your contract is executed, establishing your network participation status, effective dates, billing terms, and official fee/reimbursement schedules.
Why it matters: Credentialing gets you approved, but Contracting gets you the legal right to get paid. You must complete both to legally see panel clients.
Q: What is EDI Enrollment?
What it is: Electronic Data Interchange. This setup links your EHR system directly to the insurance clearinghouse so you can send digital claims instantly.
How urgent is it? Extremely Urgent. Without EDI setup, you cannot submit digital insurance claims, forcing you to mail slow, easily lost paper claims.
Q: What is ERA Enrollment?
What it is: Electronic Remittance Advice. This replaces paper "Explanation of Benefits" (EOBs) with digital payment data sent straight to your system.
How urgent is it? Highly Necessary. ERA automates your workflow, allowing your system to automatically post payouts and track exactly why a claim was paid or denied without manual data entry.
Q: What is EFT Enrollment?
What it is: Electronic Funds Transfer. This securely links your business bank account to insurance payers.
How urgent is it? Highly Necessary. Instead of waiting weeks for paper checks to arrive in the mail and taking trips to the bank, EFT deposits your insurance reimbursements directly into your bank account.
Q: What is RCM (Revenue Cycle Management)?
What it is: The entire financial workflow of your practice. It starts the moment a client schedules an appointment and includes eligibility checks, copay collection, coding, claim submission, tracking denials, and final payment posting.
Why it matters: A broken RCM workflow means delayed payments or lost revenue. At Stelleo Billing Solutions, we manage this entire cycle for you so your cash flow remains steady and predictable.
