Claim Submission & Tracking: The Cash Flow Engine

(Part 2 of the RCM 101 Series for Clinician-Owned Practices, here's part 1 in case you missed it)

Why submission & tracking matter for behavioral health practices

When a client receives care, the session’s value is only realized when the claim is submitted and tracked until paid. For behavioral-health practices, with multiple session types (individual, group, telehealth), varied payer rules, and high administrative burden, claim submission and tracking are key drivers of financial health.

Consider some of the data:

• Industry benchmark for a clean-claim rate (claims submitted without errors requiring no manual correction) is 90 % or higher. ICANotes+1

• Claims denied or rejected often tie back to front-end errors or delays (such as eligibility, documentation, coding) which slow payment and increase cost.

• According to a recent guide, more than 15 % of all denied claims result from late filings or procedural delays. CapMinds -+1

The decision-point for your practice isn’t just whether you submit claims, it’s how well and how fast. Every delay or error drains cash flow, decreases your flexibility, and distracts from care.

Key submission & tracking steps (and how to optimize them)

Here’s a breakdown of the major stages of submission & tracking, and best-practice actions for behavioral-health practices.

1. Charge capture → Claim creation

Once the session is delivered and documented, the charge must be captured and a claim constructed.
Best-practice tips:

• Ensure documentation maps to billing codes clearly. In behavioral health, modifiers (telehealth, group, E/M + therapy) matter.

• Automate charge capture as much as possible to reduce human error and missing services. A guide on claims submission notes that poor charge capture can contribute to revenue loss of 3-5% annually. MBW RCM

2. Claim scrubbing & validation

Before submission, claims should be validated through a clearinghouse or software for common issues: missing provider NPI, invalid member IDs, filing indicators, correct CPT/ICD codes.
Why this matters:

• A report indicates manual workflows average clean claim acceptance rates of 70-80%, whereas cleanly scrubbed claims can achieve 95%+. MBW RCM

• In behavioral-health billing, one metric piece noted that nearly 45% of rejected claims were due to missing information, and 24% due to eligibility issues. ICANotes

Best Practices:

• Use automated claim-scrubbing tools tailored to your commonly used payers and service types.

• Maintain templates for your most frequent claim types (e.g., 90837 psychotherapy, group therapy codes) to speed creation and reduce variation.

• Frequently review rejection reasons coming out of the clearinghouse to refine your scrubbing rules.

3. Timely electronic submission

Once scrubbed, the claim should be submitted electronically (ideally daily or twice a week ) rather than weekly or monthly.
Best-practice data:

• Many payers have “timely filing” deadlines (often 90 days, sometimes less) from date of service to claim submission. Late filing is a common source of denial.

• Early submission reduces the risk of missing deadlines, improves cash-flow speed, and lowers admin load.

Best-practice tips:

• Set an internal target: submit within 24-48 hours of service (if verification and documentation are ready).

• Monitor your submission queue daily for any claims pending past your target.

• Keep a documented list of each payer’s timely-filing rules; embed alerts if your claims-system allows.

4. Tracking & monitoring until payment

Submitting a claim is not the end—it’s a step. Tracking means knowing: when it was submitted, whether it was accepted/acknowledged, whether it’s under review or paid, or whether it needs follow-up.
Important metrics to track:

• Days in A/R (accounts receivable): top performers aim for below ~35-45 days. Enter Health+1

• First-pass payment rate: the percentage of claims paid without needing corrections/appeals. Industry target: ~90%+. ICANotes+1

Best-practice tips:

• Use dashboards to visualize claims by status (submitted, acknowledged, paid, denied, aged > X days).

• Flag any claim that sits idle more than your benchmark (e.g., 20-30 days) for immediate action.

• Identify patterns: which payers, service types, or clinician lines have higher aged claims or denials? Use this for process improvement.

5. Remediation & root-cause analysis

When a claim is denied or underpaid, the key isn’t just resubmit it’s understand why. Denials are expensive: one article reported cost to rework a denied claim ranged from $25-$117. ICANotes
Best-practice tips:

• Maintain a denial register capturing payer, reason, date of service, clinician, service type.

• Weekly or monthly review of top denial reasons; revise upstream workflows (intake, documentation, coding) accordingly.

• Appeal where appropriate—but also decide when to write off or re-bill to patient faster.

Real-world behavioral health considerations

Behavioral-health practices face particular nuances:

• Multiple session types (individual, family, group) and telehealth modifiers demand accurate coding and service capture.

• Payer rules may limit number of sessions, require prior authorisation, or have non-standard filing rules.

• High-deductible plans and patient responsibility rates require good patient-billing integration and clear communication.

• Many practices are clinician-owned and lean, so revenue cycle inefficiencies can disproportionately impact growth and sustainability.

How to build or refine your submission & tracking engine

1. Actionable steps for practice owners and RCM leads:
2. Define your benchmarks. What is our current clean-claim rate? Days in A/R? First-pass payments? Compare to targets: clean-claim ≥ 90 %; days in A/R < 45.
3. Map your workflow. Chart every step from session delivered → charge capture → claim creation → submission → payment/denial. Identify bottlenecks (delayed documentation, delayed submission, untracked claims).
4. Automate where possible. Invest in tools that:
   • Generate claims from documentation automatically.
   • Scrub claims before submission.
   • Monitor claim status and trigger alerts for aged claims.
5. Establish SLAs. For example: claims submitted within 48 h; claims aged >30 days get escalation.
6. Train your team or bring in a partner. Everyone in intake, clinical documentation, coding, billing should understand how their role affects the cycle. Account for this team in your business planning or find a strong partner (like Breksey) who can bring this expertise to your business. 
7. Review and improve monthly. Pull KPI reports; identify trends (high denials for a payer, repeated rejections for a service type); implement remediation plans.

Why this matters for clinician-owners

As a practice owner or clinician-leader, your ability to invest in new clinicians, programs, or services depends on reliable revenue. When claims sit in limbo, or staff are consumed by chasing payment instead of delivering care, growth stalls.

By building a robust claim submission and tracking engine:

• You convert delivered care into actual revenue faster.

• You reduce staff burden and administrative distraction.

• You build predictability into cash flow which makes strategic planning possible.

• You free up your energy and your team’s to focus on care and culture, not chaos.

What’s next?

In Part 3 of our RCM 101 series, we’ll focus on Adjudication & Denial Handling: Turning Data into Dollars—how to analyze and act on claims outcomes and build a denial-resilient revenue cycle.