Where Cortexa fits
Cortexa is an operations team for independent therapy practices that runs the front desk, intake, billing, credentialing and payroll as one team. Billing runs about 3% of what you collect, and the front desk, intake and billing together about 6%. There's no long-term contract, and there's a 30-day money-back guarantee.
With Cortexa running billing, collections went from 82% to 97% of billed revenue. On $120,000 billed a month, 15 points is $18,000, three times a 6% fee on $100,000 collected. See whether it pays for itself with your numbers.
Six ways to get your billing done
Every option below submits claims and follows them to payment, and they differ in cost basis, who manages the work and who covers the gaps. For prices, see our mental health billing cost guide.
Full-time in-house biller
Your employee files claims, posts payments, works denials and sends statements in your systems. The cost is a salary plus benefits, about $69,300 a year in the BLS-based illustration in our cost guide. You train and supervise them, and billing waits when they're out. Fits a practice with steady volume, someone to supervise, and a second person who can cover.
Part-time biller
An employee who works a set number of hours a week. At the BLS median of $23.32 an hour, 20 hours a week is about $24,250 a year before benefits. A fixed number of hours can fall behind when claims pile up or denials spike. Fits a small practice with clean intake data and a predictable caseload.
Freelance or contract biller
An independent biller who sets their own rate and may work for other practices too. You get an experienced biller without hiring one. The risks are continuity, time split across other clients, and HIPAA paperwork. If they work outside your direct control, they're a business associate and need a signed agreement. Fits a solo or small practice that reviews the work every month.
Billing company
A company that bills for many practices for a percentage or a flat monthly fee. Ask who covers your account when your contact is out. It's a business associate, so you sign a BAA with it. It works from what your front desk records, so errors made at intake reach it late. Fits a practice whose front desk and intake already run well.
A platform such as Headway or Alma
You see insurance clients through the platform's insurance program. Alma, for example, charges a membership fee and credentials members under Alma's tax ID, so those contracts are Alma's. Fits a clinician who wants insurance clients without holding contracts in the practice's name. See our Headway and Alma guide.
A full-service operations team
One team runs the front desk, intake, billing, credentialing and payroll. The person who checks eligibility at intake works on the same team as the person who files the claim. Fits a group practice where the owner is the one connecting intake, billing and payroll.
The options side by side
The biggest differences are who manages the work, whose insurance contracts the claims use, and what HIPAA paperwork you need.
| Option | Cost basis | Who manages the work | Whose contracts | HIPAA paperwork |
|---|---|---|---|---|
| Full-time biller (employee) | Salary plus benefits | You | Yours | Part of your workforce |
| Part-time biller (employee) | Hourly wage | You | Yours | Part of your workforce |
| Freelance biller | Their own rate | You | Yours | BAA unless under your direct control |
| Billing company | Percentage or flat monthly fee | The company | Yours | BAA |
| Alma (a platform) | Membership fee | Alma, for claims through Alma | Alma's tax ID | Check Alma's agreement |
| Full-service team (Cortexa) | About 3% of collections for billing, 6% with front desk | Cortexa, with you setting policy | Yours | BAA |
The work around billing that a biller doesn't see
A biller works from the session record forward, but many claim problems start earlier, at the first call and the intake form. Experian Health's 2025 State of Claims survey asked 250 healthcare professionals who make billing and claims decisions why claims are denied. The top three reasons were missing or inaccurate data (50%), authorizations (35%) and incomplete or inaccurate patient registration data (32%). The survey covers healthcare broadly, not only therapy practices. In a therapy practice, that data is collected by whoever answers the phone and sends the intake paperwork. A wrong member ID or a missed secondary insurance can show up weeks later as a denial on the biller's desk. The biller can correct that claim, but the next new client goes through the same intake step. So when you compare a biller with a billing company, also decide who owns the steps before and after the claim.
These are the jobs that sit next to billing and decide how clean the claims are:
- Eligibility at intake. Someone checks coverage, the deductible and in-network status before the first session.
- Registration data. The client's name, date of birth, member ID and subscriber details have to match the insurer's records.
- Clinician notes. The note has to support the code billed, for example 90837 versus 90834. The clinician decides the code and writes the note.
- Client balances. Copays, deductibles, statements, payment plans, and the call when a client questions a bill.
- Payroll by session. If clinicians are paid per session, someone matches the sessions in the EHR to each payroll run.
How the workload grows with practice size
A therapy practice's billing work grows in step with its clinicians, and so does the cost of a week with nobody filing claims. Take an illustration that assumes 20 insurance sessions per clinician per week, one claim per session and 52 weeks spread over 12 months. A 3-clinician practice then sends about 260 claims a month, an 8-clinician practice about 690 and a 15-clinician practice about 1,300. If we also assume 1 in 10 claims needs follow-up, that's about 26, 69 and 130 follow-ups a month. With 2 new clients per clinician per month, eligibility checks run to 6, 16 and 30. A week with no biller leaves 60, 160 or 300 claims unfiled. None of these figures is market data. Each one follows from the assumptions, so swap in your own caseload to see your numbers.
| Illustration | 3 clinicians | 8 clinicians | 15 clinicians |
|---|---|---|---|
| Sessions a week | 60 | 160 | 300 |
| Claims a month | About 260 | About 690 | About 1,300 |
| Claims needing follow-up a month | About 26 | About 69 | About 130 |
| New-client eligibility checks a month | 6 | 16 | 30 |
| Claims waiting after one week with no biller | 60 | 160 | 300 |
How to hire a biller well
A biller is the right choice for many practices. These six steps make the hire safer and keep the practice from depending on one person's memory.
- Write down the job
List every step you're handing over: charge entry, claim submission, payment posting, denials, appeals, client statements and eligibility checks. Name what stays with you.
- Ask about mental health billing
Ask which of your payers they've billed, how they bill 90837 versus 90834, supervised clinicians and telehealth claims, and how they track filing deadlines.
- Test with real work
Give them three sample denials or remittances with every client detail removed. Ask what they'd do next and why.
- Set up access properly
Give them their own login, never yours. HIPAA's Security Rule requires a unique user ID for each person. Grant only the access the job needs.
- Sign the right paperwork
An employee is part of your workforce under HIPAA. A freelancer or company outside your direct control is a business associate, so sign a business associate agreement before they see any client record.
- Plan for cover and exit
Keep payer portals and the clearinghouse account in the practice's name. Write down the procedures. Read the aging report yourself every month so a gap shows up early.
When a full-service team is the better fit
If you have a biller you trust and your intake runs well, keep them. A billing company is also a good choice when claims are the only gap. A full-service team fits when the owner is the one connecting intake, billing, credentialing and payroll.
On billing, we file claims after sessions, monitor them, follow up on pending and denied claims and pursue appeals where appropriate. We review clinically substantive appeals with you first. We set up and maintain supervisory and incident-to billing under your payer contracts, and a named billing lead looks after your account.
We check coding against payer expectations, for example 90837 versus 90834 use, and give guidance so notes support the codes billed. Coding and documentation decisions stay with your clinicians. We manage insurance credentialing for new applications, renewals and status tracking, passed through at our actual documented cost, and your contracts stay in your practice's name.
Cortexa's own team runs reception. They're employees and contractors working under our direction, on our systems and under the same confidentiality and HIPAA terms. We don't hand reception to another company. We sign a BAA. It's a billing team that follows every claim until it's paid, and you can check the status of any claim on your dashboard, any time. You can start with only the work you need most. See how our billing service works.
Common questions
How much does a mental health biller cost?
An employed biller costs a wage plus benefits. BLS doesn't track medical billers separately. The closest occupation, billing and posting clerks, had a median wage of $23.32 an hour in May 2025, about $48,500 a year. In June 2026, benefits made up 30% of private employers' compensation costs, on top of wages. A billing company charges a percentage or a flat fee instead. See our billing cost guide.
Is it better to hire a biller or outsource?
Hire when you have steady claim volume, clean intake data, someone to supervise the biller and a plan for cover. Outsource to a billing company when you'd rather pay a percentage or flat fee than manage a person, and your front desk already collects accurate insurance details. If claim problems start before the claim, at intake or eligibility, look for a team that owns those steps too.
Do I need a BAA with a freelance biller?
Usually, yes. Under HIPAA, someone who handles protected health information for billing on your behalf is a business associate unless they're part of your workforce. Workforce means people whose work is under your direct control, paid or not. If you don't direct a freelancer's work that way, treat them as a business associate. HIPAA requires that relationship to be documented in a written contract before they handle client records. Ask a healthcare lawyer if you're unsure.
What happens when my biller quits?
Claims stop going out and follow-up stops, while filing deadlines keep running. Medicare, for example, denies claims submitted more than one calendar year after the date of service, with a few exceptions. Check each payer contract for its own limit. Protect yourself before it happens. Keep payer portals and the clearinghouse account in the practice's name, keep written procedures, and read the aging report every month.
Can a part-time biller handle a group practice?
Sometimes, at the small end. In our illustration, assuming 20 insurance sessions per clinician a week, a 3-clinician practice sends about 260 claims a month and an 8-clinician practice about 690. Whether part-time hours cover that depends on how long each claim takes and how many need follow-up. Time the work for a month before you decide, and name who files claims when the biller is out.