Every dollar a therapy practice collects travels the same road. As a Sharp specialist you will work on almost every step of it, so you need the whole map before the details.
The ten steps
- Scheduling and intake. The patient calls or books online. Demographics and insurance card are collected.
- Eligibility and benefits. Is the plan active? Is the provider in network? What will the patient owe?
- Authorization (when required). Some plans need approval before sessions start or after a number of visits.
- The session. The clinician sees the patient and writes the note.
- Charge entry and coding. The session becomes a charge: CPT code, diagnosis code, place of service, modifiers.
- Claim submission. The claim goes to the payer, usually through a clearinghouse.
- Adjudication. The payer decides what to pay and explains it on an ERA/EOB.
- Payment posting. The payment and adjustments are recorded against the charge.
- Patient billing. Whatever the plan assigned to the patient is billed to them.
- Follow-up. Denials, underpayments and unpaid claims are worked until they are resolved.
The standards you will work to
Sharp runs billing and credentialing to the SNG Practice Standards: measurable targets for each stage of the cycle. These are the core ones you will be held to on the job:
| Stage | Core standard | Target |
|---|---|---|
| Before the visit | Verify eligibility and behavioral health benefits for every new patient | 100%, at least 2 business days ahead |
| The session | Clinician signs and locks the note | 95% within 48 hours |
| Claims | Submit the claim after the date of service | 95% within 3 business days |
| Payments | Post payments after the ERA arrives | 100% within 2 business days |
| Denials | Work every denial after the remittance | 100% within 7 calendar days |
| Credentialing | Re-attest CAQH; keep license, malpractice and W-9 current | Every 120 days, 100% |
Where mental health is different
- Sessions are recurring: one patient may produce 40+ claims a year, so one wrong setting repeats 40 times.
- Behavioral health carve-outs: the medical card may say Blue Cross while mental health is managed by another company. Always check who manages behavioral benefits.
- Timed codes: psychotherapy codes depend on minutes, so the note and the code must agree.
- Privacy is stricter in practice: patients are often more sensitive about who knows they are in therapy.
The three people you serve
- The patient, who wants to understand what they owe and why.
- The practice (our client), which wants clean claims, fast payment and no surprises.
- The payer, which follows its own rules. You don’t serve the payer, but you must speak its language.
Your job is to keep all three aligned. The rest of this program teaches you how.