Most billing companies use a one-size-fits-all approach.

Tidemark VA is different.

Most billing companies use a one-size-fits-all approach.

Tidemark VA is different.

Most billing companies use a one-size-fits-all approach.

Tidemark VA is different.

60%

of medical groups report their claim denial rates increased in 2024

WHY CHOOSE US

We’re designed specifically for mental health and specialty practices.

We’re designed specifically for mental health and specialty practices.

The results? Fewer denials and steadier cash flow.

We review your claims

We dig into your claims data to find the money you're owed.

We check your notes

We find documentation issues before they become billing problems.

We catch coding errors

We review CPT/HCPCS codes and modifiers before claims go out.

We fix what others miss

When something doesn't look right, we correct it or come to you for clarification.

Most billing companies use a one-size-fits-all approach.

Tidemark VA is different.

Most billing companies use a one-size-fits-all approach.

Tidemark VA is different.

WHY CHOOSE US

We’re designed specifically for mental health and specialty practices.

We review your claims

We dig into your claims data to find the money you're owed.

We check your notes

We find documentation issues before they become billing problems.

We review CPT/HCPCS codes and modifiers before claims go out.

We catch coding errors

When something doesn't look right, we correct it or come to you for clarification.

We fix what others miss

WHY CHOOSE US

We’re designed specifically
for mental health and specialty practices.

We review your claims

We dig into your claims data to find the money you're owed.

We check
your notes

We find documentation issues before they become billing problems.

We catch coding errors

We review CPT/HCPCS codes and modifiers before claims go out.

We fix what others miss

When something doesn't look right, we correct it or come to you for clarification.

WHY CHOOSE US

We’re designed specifically for mental health and specialty practices.

The results? Fewer denials and steadier cash flow.

We review your claims

We dig into your claims data to find the money you're owed.

We check your notes

We find documentation issues before they become billing problems.

We catch coding errors

We review CPT/HCPCS codes and modifiers before claims go out.

We fix what others miss

When something doesn't look right, we correct it or come to you for clarification.

Medical Billing We Specialize In:

Specialty Mental Health

Not every state and payer allows billing for ketamine services. We research each payer's rules so you don't have to guess. Billing for a service that's experimental or investigational can count as insurance fraud; we make sure that never happens to you.

We know how to properly tie brain mapping and biofeedback codes to the correct mental health diagnoses so your claims clear on the first run.

Prism isn't billed like a typical behavioral health service. We understand the unique coverage, authorization, and reimbursement considerations that come with offering this specialized treatment and help practices navigate them from the start.

We're part of your Spravato workflow from day one.

We check eligibility to see if it's covered under buy-and-bill (your clinic purchases the drug and bills insurance for it) or pharmacy benefits.
Once you've done the evaluation and clinical note, we submit the prior authorization.
We track expiration dates and get new authorizations before they run out (most plans only approve the first four visits).
We make sure the CPT codes (the billing codes that identify exactly which service was performed) match what was approved.

Denials usually happen for two reasons: the authorization expired, or the wrong CPT code was billed. Each buy-and-bill visit can cost your clinic $1,200 to $1,500, so a denial can hurt fast.

We're part of your Spravato workflow from day one.

We check eligibility to see if it's covered under buy-and-bill (your clinic purchases the drug and bills insurance for it) or pharmacy benefits.
Once you've done the evaluation and clinical note, we submit the prior authorization.
We track expiration dates and get new authorizations before they run out (most plans only approve the first four visits).
We make sure the CPT codes (the billing codes that identify exactly which service was performed) match what was approved.

Denials usually happen for two reasons: the authorization expired, or the wrong CPT code was billed. Each buy-and-bill visit can cost your clinic $1,200 to $1,500, so a denial can hurt fast.

Our team fights the prior authorization hurdles that stem from poor clinical note documentation and strict daily session limits that insurers use to avoid paying you for the services you perform.

Common reasons TMS gets denied:

Notes don't show two failed antidepressant trials from different drug classes, with exact start and stop dates (each trial must last eight weeks).
Notes don't list prior psychotherapy or psychiatric care, including provider, location, and dates (notes also must span eight weeks).
Assessment scores don't match a diagnosis of Major Depressive Disorder (MDD), Severe, Recurrent, or Obsessive Compulsive Disorder (OCD).

We also help you get paid more and get covered when it counts:

NCCI (National Correct Coding Initiative) rules allow up to two units per day for TMS, even though payers often try to limit you to one. We fight for what you're owed.
We appeal when payers deny faster treatment schedules, even when payers call them unnecessary or experimental.
We get TMS covered for patients under the standard age criteria.

Our team fights the prior authorization hurdles that stem from poor clinical note documentation and strict daily session limits that insurers use to avoid paying you for the services you perform.

Common reasons TMS gets denied:

Notes don't show two failed antidepressant trials from different drug classes, with exact start and stop dates (each trial must last eight weeks).
Notes don't list prior psychotherapy or psychiatric care, including provider, location, and dates (notes also must span eight weeks).
Assessment scores don't match a diagnosis of Major Depressive Disorder (MDD), Severe, Recurrent, or Obsessive Compulsive Disorder (OCD).

We also help you get paid more and get covered when it counts:

NCCI (National Correct Coding Initiative) rules allow up to two units per day for TMS, even though payers often try to limit you to one. We fight for what you're owed.
We appeal when payers deny faster treatment schedules, even when payers call them unnecessary or experimental.
We get TMS covered for patients under the standard age criteria.

Traditional Mental Health

Running these programs means proving medical necessity against criteria set by the American Society of Addiction Medicine (ASAM), and your documentation has to back it up.

What we handle:

We submit the initial prior authorization within 24 to 48 hours of admission, since payers require it fast.
We track strict payer requirements, like failed step therapy trials (proof the patient already tried a lower level of care or treatment first) or a needed physical exam.
We watch authorization windows closely (three days for detox, seven to 14 days for PHP/IOP) and submit renewals before they expire, since payers won't pay after the fact.
We help you avoid common traps that lead to denials. For example, payers may deny further care if the documentation says the patient is "stable," even when more treatment is still needed.

Running these programs means proving medical necessity against criteria set by the American Society of Addiction Medicine (ASAM), and your documentation has to back it up.

What we handle:

We submit the initial prior authorization within 24 to 48 hours of admission, since payers require it fast.
We track strict payer requirements, like failed step therapy trials (proof the patient already tried a lower level of care or treatment first) or a needed physical exam.
We watch authorization windows closely (three days for detox, seven to 14 days for PHP/IOP) and submit renewals before they expire, since payers won't pay after the fact.
We help you avoid common traps that lead to denials. For example, payers may deny further care if the documentation says the patient is "stable," even when more treatment is still needed.

We submit claims, work rejections, and denials daily, making sure the right codes are always applied:

Time-based codes, tied to how long a session lasted rather than a flat visit code.
Place of service, showing where the visit happened (like office or telehealth).
Revenue codes, used by facilities to categorize the service billed.
Modifiers, extra codes that add detail like session length or type.

For prescribers, CPT codes get chosen based on time or complexity, whichever earns the most accurate revenue, and we review the notes ourselves to make that call.

We submit claims, work rejections, and denials daily, making sure the right codes are always applied:

Time-based codes, tied to how long a session lasted rather than a flat visit code.
Place of service, showing where the visit happened (like office or telehealth).
Revenue codes, used by facilities to categorize the service billed.
Modifiers, extra codes that add detail like session length or type.

For prescribers, CPT codes get chosen based on time or complexity, whichever earns the most accurate revenue, and we review the notes ourselves to make that call.

A medication visit has two parts:

Checking in on the patient (the evaluation and management, or E/M part)
Any therapy that happens during the same visit (the "psychotherapy" part)

Insurance requires the notes to clearly separate these. We catch the small coding differences between E/M codes and psychotherapy add-ons to safely maximize your session value while ensuring the coding is compliant with clinical documentation.

Many providers just write down a start and stop time, like "11:00-12:00," without saying what actually happened. That's not enough for insurance. Good notes show:

How long the visit was and how much of it was therapy (e.g., 60 minutes total, 23 minutes of therapy).
What was talked about (e.g., teaching the patient about their medication).
What therapy method was used (e.g., CBT).
How the patient is doing, not just "no side effects," but real changes in their mood or symptoms.

A medication visit has two parts:

Checking in on the patient (the evaluation and management, or E/M part)
Any therapy that happens during the same visit (the "psychotherapy" part)

Many providers just write down a start and stop time, like "11:00-12:00," without saying what actually happened. That's not enough for insurance. Good notes show:

How long the visit was and how much of it was therapy (e.g., 60 minutes total, 23 minutes of therapy).
What was talked about (e.g., teaching the patient about their medication).
What therapy method was used (e.g., CBT).
How the patient is doing, not just "no side effects," but real changes in their mood or symptoms.

We bill the correct number of units for testing, scoring, evaluation hours, and interpretations, so you get paid for the time you actually worked.
We check eligibility to see if testing falls under a different tier of benefits, which can mean higher out-of-pocket costs for the patient.

We bill the correct number of units for testing, scoring, evaluation hours, and interpretations, so you get paid for the time you actually worked.
We check eligibility to see if testing falls under a different tier of benefits, which can mean higher out-of-pocket costs for the patient.

Our team handles the complex parts of substance use disorder billing:

Coordination of benefits between multiple payers.
Appealing underpriced claims that violate state and federal laws.
Cases where insurance sends behavioral health claims to a different company to handle.

Our team handles the complex parts of substance use disorder billing:

Coordination of benefits between multiple payers.
Appealing underpriced claims that violate state and federal laws.
Cases where insurance sends behavioral health claims to a different company to handle.

Medical Specialties

We get billing codes right for scans and imaging so you're paid correctly.

We adhere to global surgery days (a time window, like 10 or 90 days, after a procedure where related follow-up visits are already covered by the original payment).
That window gets tracked closely so you're never billed incorrectly, and you still get paid for anything genuinely separate.

We get billing codes right for scans and imaging so you're paid correctly.

We adhere to global surgery days (a time window, like 10 or 90 days, after a procedure where related follow-up visits are already covered by the original payment).
That window gets tracked closely so you're never billed incorrectly, and you still get paid for anything genuinely separate.

We keep your claims protected against aggressive utilization limits (caps on how many visits or services insurance will cover).
Extraspinal manipulation (adjustments outside the spine, like shoulders or hips) and modality exclusions (treatments Medicare won't cover, like heat or ultrasound) are issues we watch for.
We keep your claims ready for documentation audits (insurance reviewing your notes to confirm treatment was necessary), which are common in chiropractic physical medicine.

We keep your claims protected against aggressive utilization limits (caps on how many visits or services insurance will cover).
Extraspinal manipulation (adjustments outside the spine, like shoulders or hips) and modality exclusions (treatments Medicare won't cover, like heat or ultrasound) are issues we watch for.
We keep your claims ready for documentation audits (insurance reviewing your notes to confirm treatment was necessary), which are common in chiropractic physical medicine.

We verify deductibles and annual maximums (the cap on how much dental insurance will pay out per year, unlike most medical plans).
We check for downgrades (when insurance pays for a cheaper, simpler procedure instead of what was actually performed).
We confirm frequency limitations and waiting periods before treatment.
We make sure oral surgeries and cross-over procedures (procedures that could be billed under either medical or dental insurance) are fully covered.

We verify deductibles and annual maximums (the cap on how much dental insurance will pay out per year, unlike most medical plans).
We check for downgrades (when insurance pays for a cheaper, simpler procedure instead of what was actually performed).
We confirm frequency limitations and waiting periods before treatment.
We make sure oral surgeries and cross-over procedures (procedures that could be billed under either medical or dental insurance) are fully covered.

ER visits often involve two separate bills (dual billing structures), one from the doctor and one from the facility. We navigate both correctly.
Same group consolidation combines charges from providers in the same group so they're billed together correctly instead of getting flagged as duplicates.
The provider's care and facility charges are handled together to maximize your revenue.
We watch for cloned clinical notes, notes that look copy-pasted between patient visits, since payers flag this and it can trigger a denial or audit.

ER visits often involve two separate bills (dual billing structures), one from the doctor and one from the facility. We navigate both correctly.
Same group consolidation combines charges from providers in the same group so they're billed together correctly instead of getting flagged as duplicates.
The provider's care and facility charges are handled together to maximize your revenue.
We watch for cloned clinical notes, notes that look copy-pasted between patient visits, since payers flag this and it can trigger a denial or audit.

Oncology drugs are expensive, and we track which ones are likely to get denied or require step therapy (insurance requiring a cheaper drug to be tried first before approving the pricier one).
Drug wastage reporting gets handled correctly, since it's a big part of this industry.
We track the timing and order of IV pushes and infusions, and know the difference between billing for chemotherapy versus therapeutic hydration.
Reauthorizations for each treatment cycle are handled as they come up.

Oncology drugs are expensive, and we track which ones are likely to get denied or require step therapy (insurance requiring a cheaper drug to be tried first before approving the pricier one).
Drug wastage reporting gets handled correctly, since it's a big part of this industry.
We track the timing and order of IV pushes and infusions, and know the difference between billing for chemotherapy versus therapeutic hydration.
Reauthorizations for each treatment cycle are handled as they come up.

We manage prior authorizations to keep prescriptions moving without delays.
We account for patient responsibility (the portion of the bill the patient owes, like copays or deductibles).
We apply precise drug dispensing fees (the fee charged for filling a prescription) to protect margins.

We manage prior authorizations to keep prescriptions moving without delays.
We account for patient responsibility (the portion of the bill the patient owes, like copays or deductibles).
We apply precise drug dispensing fees (the fee charged for filling a prescription) to protect margins.

Before billing, we check whether routine foot care will be covered. This depends on whether the patient has an underlying systemic condition (like diabetes) that makes the care medically necessary.

We use Q modifiers (codes that flag specific clinical findings) to support your reimbursement without triggering unexpected denials.

Before billing, we check whether routine foot care will be covered. This depends on whether the patient has an underlying systemic condition (like diabetes) that makes the care medically necessary.

We use Q modifiers (codes that flag specific clinical findings) to support your reimbursement without triggering unexpected denials.

We know the difference between surgical and selective debridement, two wound cleaning methods that get billed differently, and we make sure the size vs. layer measurements documented by the provider translate into the correct billing code.
We apply modifiers accurately (extra codes that flag when a procedure was more complex, on a different body part, or repeated).
We translate the provider's documentation into the correct number of billable units, like per square centimeter of a skin graft applied.
We use the right Q code sequence (billing codes for skin substitutes and grafts).

Getting these details right is what maximizes your reimbursement instead of leaving money on the table.

We know the difference between surgical and selective debridement, two wound cleaning methods that get billed differently, and we make sure the size vs. layer measurements documented by the provider translate into the correct billing code.
We apply modifiers accurately (extra codes that flag when a procedure was more complex, on a different body part, or repeated).
We translate the provider's documentation into the correct number of billable units, like per square centimeter of a skin graft applied.
We use the right Q code sequence (billing codes for skin substitutes and grafts).

Getting these details right is what maximizes your reimbursement instead of leaving money on the table.