Insurance denials are not a billing problem. They’re a behavioral health problem.
Mental health claims get denied at higher rates than any other specialty, and SUD practices have 42 CFR Part 2 rules that most billing tools were never designed for. PIMSY billing handles electronic claims, real-time eligibility, and authorization tracking built specifically for behavioral health payers.
Medical billing and behavioral health billing are not the same problem.
Insurers deny mental health and substance use claims at rates far higher than physical health. Mental health parity laws are on the books, but enforcement is inconsistent and appeals take time your staff doesn’t have. SUD practices operate under 42 CFR Part 2, which limits what you can put on a claim without violating federal confidentiality rules. Authorizations expire mid-treatment if nobody’s tracking them. And superbills for self-pay clients need to go out fast or the revenue walks out the door with the client.
Where the money leaks out
Denials pile up with no clear owner
A claim comes back denied. Someone writes it on a sticky note. A week passes. The denial deadline passes. That revenue is gone. Without a system that surfaces denials and tracks resubmissions, you’re losing money you’ve already earned.
Authorizations expire and nobody notices
Your therapist sees a client on Tuesday. The authorization expired two weeks ago. You find out when the claim comes back denied. Now you’re either writing off the session or spending hours on a retroactive auth appeal that may not work.
Eligibility calls eat your morning
Your biller calls the insurance line to verify benefits before the first appointment. They’re on hold 20 minutes. Then they do it again for the next client. Then the next. That’s not a billing process, that’s a full-time job you didn’t budget for.
Every tool your billing team needs, and nothing they don’t.
PIMSY connects every step of your billing workflow, from insurance verification before the first session to ERA posting when the payment comes in. Your billers spend less time chasing information and more time closing claims.
Need to bill commercial insurance, Medicaid, and self-pay clients out of the same system? PIMSY handles all three. Superbills go out to self-pay clients in a few clicks. Commercial claims go through your clearinghouse of choice.
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Electronic claims submission to all major payers, including Medicaid and commercial insurance -
Real-time eligibility verification checks insurance coverage before the appointment, not after a denial
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Authorization management is tied to the scheduling calendar, so you see auth status before you book the session
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ERA and EOB posting pulls remittance data directly, so payments get applied without manual entry
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Superbill generation for self-pay clients with the detail they need for out-of-network reimbursement
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Credit card processing via Fiserv and Global Payments, built into the same interface as your claims
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UB-04 and residential billing available for inpatient and residential programs in PIMSY
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Chart deficiency tracking is tied to billing, so incomplete notes don’t get submitted as clean claims
From insurance check to payment posted, in one system
PIMSY connects every billing step so your team isn’t copying data between platforms or catching errors after the fact.
Verify coverage before the appointment
Real-time eligibility verification checks insurance benefits when you need it: at intake, before each session, or in batch for your full schedule. You know what’s covered before the client walks in.
Submit clean claims with one click
After the session, your note ties directly to the claim. Chart deficiency tracking flags incomplete documentation before submission. Your clearinghouse of choice handles transmission to the payer.
Post payments and manage denials
ERA posting pulls remittance data automatically. Denied claims surface in your queue so your team can resubmit quickly. You see exactly where every dollar stands without digging through paper EOBs.
Billing is part of a bigger picture
PIMSY connects billing to the clinical and administrative tools your team already uses every day. No silos, no double entry.
Questions about PIMSY billing
Which clearinghouses does PIMSY connect to?
PIMSY connects to Claim MD, Office Ally, Trizetto, and Waystar. You can use whichever clearinghouse your practice already has a relationship with, or we can help you set up a new connection. All four handle electronic claims submission to major commercial payers and Medicaid.
How does PIMSY handle 42 CFR Part 2 for SUD practices?
PIMSY is built with 42 CFR Part 2 compliance in mind. The billing module handles SUD claims with the confidentiality protections that federal law requires, including controls over what information can appear on claims submitted to payers. If you’re billing for substance use treatment, PIMSY knows the rules.
Can PIMSY check insurance eligibility before every session, not just at intake?
Yes. Real-time eligibility verification is available any time, so your team can check coverage at intake, before a session, or whenever a client’s insurance situation may have changed. PIMSY users also get batch eligibility verification, which checks your entire upcoming schedule in one pass.
Does PIMSY track prior authorizations?
Yes. Authorization management is integrated with the scheduling calendar. When you book a session, you can see the authorization status for that client’s insurance. Authorizations are tracked by number of approved sessions and expiration date, so your team gets a heads up before a client runs out of covered visits.
Does PIMSY support billing for residential and inpatient programs?
Yes. UB-04 billing and residential billing features are available in PIMSY. If you run an inpatient or residential program alongside outpatient services, PIMSY can handle both billing types in the same system without switching platforms. Clearinghouse fees may apply from the clearinghouse provider.
How does PIMSY handle claim denials?
Denied claims surface in your billing queue automatically when ERA data comes back from the clearinghouse. Your team sees the denial reason, can correct the claim, and resubmit without leaving PIMSY. Chart deficiency tracking also helps prevent a common cause of denials: incomplete documentation at the time of submission.
Stop writing off revenue you’ve already earned.
PIMSY’s billing tools are built for the payer mix, authorization requirements, and confidentiality rules that behavioral health practices deal with every day.
- ✓ Real-time eligibility before every session
- ✓ Authorization tracking tied to the scheduling calendar
- ✓ Electronic claims to all major payers via your choice of clearinghouse
- ✓ 42 CFR Part 2 compliant billing for SUD practices