Automated Billing for Mental Health Practices 

Not usually. You turn on the automation steps you want (invoice creation, invoice processing, claims submission, and/or ERA processing) and set exclusion rules for the situations you don’t want to have automated. The system then runs those automations on a nightly schedule and leaves a one-day review window between steps so you can spot-check before things before moving forward.

TheraNest can automate four parts of insurance billing:

• Invoice creation for new appointments, or for appointments whose clinical documentation is newly signed.
• Invoice processing, which prepares the claims for submission.
• Claim submission, which transmits claims to the payers.
• ERA processing, auto-post ERAs according to your posting rules, or block them from posting if they meet certain conditions.

No. You can still track claim statuses in the Claims Manager (Submitted, Accepted, Rejected, and more), and the system checks for clearinghouse status updates regularly after submission. If a claim is rejected or denied, it will still be shown in the same Rejected/Denied tab for review.

If a claim doesn’t pass clearinghouse validations, its status updates to Rejected by Clearinghouse. If it’s rejected by the payer’s EDI validations, the status updates to Rejected by Payer EDI. Your biller opens the claim and clicks the Details link to see the rejection reason, corrects the issue (either by editing the claim or updating source data and regenerating), and then submits the claim again from Claims Manager.

Yes. Billing automated billing runs at the practice level, and you can use rules to control automation by payer, billing or rendering provider, CPT, modifier, or a number of other data points. That means you can roll it out across multiple clinicians while still keeping certain providers or payers out of automation until you’re ready.

Yes. You can turn automation on for a single payer or a single clinician to start. Many practices begin this way to get comfortable with the workflow before expanding. You’re not required to automate everything at once.

TheraNest can auto-post ERAs when the ERA matches your posting rules. If an ERA doesn’t match (because of payer-specific behavior or an unlisted code), it won’t be auto-posted. Instead, your team reviews it in the ERA Received area and can take the right next step, such as making adjustments, writing off balances, shifting amounts to client responsibility, or leaving it as-is.

Yes. You can configure TheraNest to hold claims for your review before submission. This is useful during the initial rollout period, or for payers where you prefer manual oversight.

Yes, at any time. You can revert to fully manual billing steps, or selectively disable automation for specific payers or clinicians while keeping it active elsewhere.

Automated billing follows the payer and plan setup you already maintain in TheraNest. You’ll still complete the normal payer configuration steps (including EDI settings) and any required clearinghouse enrollment so claims and ERAs can flow correctly. In other words: automation doesn’t replace setup — it helps the day-to-day workflow run more consistently once your setup is in place.

Automated Claims Submission won’t send claims that fail our internal claim scrub. If a claim is still rejected by the clearinghouse or payer, TheraNest updates the claim status. Your biller can then review the rejection reason, correct what caused the rejection (either by editing the claim or fixing the underlying data and regenerating it), and resubmit the claim once ready.

That’s exactly why the automation is rules-based. TheraNest will auto-post ERAs when they match your posting rules, and anything that doesn’t match can be held for review. You can also configure to handle codes where a particular action hasn’t been configured — for example, block them from auto-posting or post them as a denial — so your team stays in control when payer behavior varies.

Yes. TheraNest’s automated billing is designed for group practices. You can automate the standard submission workflow across the practice, then use provider-based exclusion rules to hold back specific clinician and payer combinations for manual review instead.
 
For example, if certain clinicians at your practice should always bill under the practice’s Type 2 NPI for a specific payer – rather than under their own – you can set a rule that blocks auto-submission whenever that payer and billing provider combination appears on a claim. The claim is held for review rather than submitted, so your billing team can correct the NPI before it goes out. Rules can be configured by primary insurer, billing provider, rendering provider, or service type, and combinations of those.
 
Your billing team can track claim statuses across all clinicians in Claims Manager and focus on the items that need attention, while routine claims keep moving on schedule.