If you are paneled with insurance in New York and nobody is working your denials, you are almost certainly leaving money on the table. Not a little. For a solo practice, it is often the difference between a good year and a tight one. Here is where the money goes and how to get it back.
How much is actually lost
Across outpatient behavioral health, first-pass denial rates commonly run 5% to 10%. Worse, a majority of denied claims are never resubmitted, because nobody has time. A therapist billing $150,000 a year with a 7% denial rate and no follow-up loses about $10,000. Add under-payments that nobody checks against the contracted fee schedule and the number grows.
The five most common reasons New York therapy claims are denied
- Eligibility not verified. The client’s plan changed in January and nobody checked.
- Missing or wrong modifier. Telehealth claims without the right place of service and modifier (95 or GT, depending on payer).
- Authorization required. Some New York Medicaid managed care plans and EAPs still require it.
- Timely filing. Many payers allow 90 to 180 days. A claim that sat in a “to fix” pile is now unpayable.
- Credentialing lapse. CAQH attestation expired, so the payer treats you as out of network.
What working denials looks like
Someone checks the ERA and clearinghouse every week, categorizes each denial, fixes and resubmits within days, appeals what deserves appeal, and posts payments against the contracted rate so under-payments get caught. It is roughly three to five hours a week for a full solo caseload.
The math
Four hours a week at $30 to $35 is about $520 to $600 a month. Recovering even half of a $10,000 annual leak is $5,000. Most practices recover far more than half once the process is consistent.
Quick answers
What percentage of therapy claims are denied?
Commonly 5% to 10% on first submission. The bigger loss is the share of denials never resubmitted.
How long do I have to resubmit a denied claim in New York?
It varies by payer, often 90 to 180 days from the date of service. Check each contract; missing the window makes the claim unpayable.
Can MBBCS take over billing for an existing practice?
Yes. We work inside your current EHR and clearinghouse, start with a backlog review of open and denied claims, then move to weekly follow-up.
Ready to talk? MBBCS is a clinician-owned practice management team in Brooklyn serving therapists across New York. Book a free 20-minute consult or get a ballpark estimate in 30 seconds.
