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.
Joy Ripplinger at Sentient Psychotherapy saves 10 hours of owner admin time each week. Owner time per payroll cycle went from 6 hours to 30 minutes, and with Cortexa running billing, collections went from 82% to 97% of billed revenue. See whether it pays for itself with your numbers.
Why “practice management” means three different things
“Practice management” is used for software, for platforms and for services, which is why comparisons get confusing. Most of the time it means software. SimplePractice describes its product as EHR and practice management software, and TherapyNotes calls itself practice management software for behavioral health.
The Psychotherapy Action Network (PsiAN), a therapist advocacy group, uses the same words for something else. It calls Headway, Alma and Grow Therapy “practice management companies” and describes them as “mega group practices” where therapists are independent 1099 contractors to the platform. Its 2025 survey of 667 mental health professionals also lists SonderMind, Rula, Spring Health and Lyra among these services. Only 17% of respondents used one, and 85% said they would not use a practice management company if they knew an insurance company had a large ownership stake in it.
“MSO” comes from law and investment. Buyers such as LifeStance Health call the practices they bring in “partners”. None of these labels tells you who holds your contracts, so the table below sorts them by that.
Who holds what under each model
The table below sorts each model by who holds the contracts, the brand and the work, and by what you give up. Examples are named only where we read the company's own pages.
| Model | Examples | Who holds insurance contracts | Whose brand | Who does front desk and billing | What you give up |
|---|---|---|---|---|---|
| Practice management software (EHR) | SimplePractice, TherapyNotes | Your practice | Yours | Your staff, using the software | A subscription, and the work stays with you |
| Network platform | Headway, Alma, Grow Therapy | The platform, under its NPI or tax ID | Yours, though payers may list the platform | Platform bills. Your practice runs the front desk | A share or a fee. Panels may not transfer |
| Billing company | TheraThink | Your practice | Yours | Billing company bills. You run the front desk | A percentage of what's collected |
| MSO | Varies | Usually the practice's own entity | Usually the practice's | The MSO, under a management agreement | A management fee. Control depends on the agreement |
| Franchise | Ellie Mental Health | Set by the franchise agreement | The franchise brand | You, on the franchise's systems | Your own name, plus fees in the agreement |
| Acquisition or roll-up | LifeStance Health | The buyer controls the business | The buyer decides | The buyer's organization | Ownership, and often your name |
| Operations team | Cortexa | Your practice | Yours | Cortexa's team, for your practice | A fee agreed before you start |
Practice management software (EHR)
Practice management software is the EHR your staff works in for scheduling, notes, claims and payments. SimplePractice and TherapyNotes are common examples in therapy practices. You keep your contracts, your brand and your clients, and you pay a subscription. The software doesn't answer the phone, chase a denial or calculate per-session pay. Your staff, a VA or a service does that work inside it. Most of the other models on this page work alongside an EHR.
Network platforms such as Headway, Alma and Grow Therapy
A network platform credentials clinicians onto its own insurance contracts and bills the claims itself. Headway's group practice FAQ says it credentials each clinician with their type one NPI and uses its own type two NPI to bill insurance. Headway says it keeps a small percentage of session payments to support its operations, and that credentialing with it doesn't affect your existing insurance contracts. Alma's support center says its credentialing gives access to rates under Alma's tax ID and can take up to 45 days. Grow Therapy's FAQ says enrollment adds you to Grow's group contracts and won't transfer outside of Grow. The trade-off is insurance access and less billing work in exchange for contracts that belong to the platform. Headway also says it can't support incident-to billing or billing for supervised, provisionally licensed therapists, which matters for a group that trains associates. A platform fits a clinician or small group that wants insurance access without setting up its own billing.
Billing companies
A billing company works under your insurance contracts and bills in your practice's name. TheraThink, for example, lists a fee of 6.5% to 8% of the contracted rate or allowed amount of each claim it helps collect. You keep your contracts, brand and clients. The front desk, intake and payroll stay with you unless you buy them separately. A billing company fits when billing is the only thing breaking. For prices across companies, read what mental health billing costs.
What is an MSO in behavioral health?
A management services organization, or MSO, is a separate business that runs the non-clinical side of a practice under a management agreement. Jackson LLP, a healthcare law firm, describes MSOs as business entities set up to manage non-clinical work such as billing, IT, human resources and real estate. The licensed clinicians keep practicing under their own professional entity. Because the MSO doesn't provide clinical care, its ownership isn't restricted by licensure. That structure lets people who aren't licensed clinicians, including investors, own the business side. The same firm notes that management fees must generally reflect fair market value, and that the MSO can't control clinical operations or treatment decisions. The agreement decides how much control moves. Read it for who controls the bank account, the staff, the payer contracts and the exit. This isn't legal advice, so have a healthcare attorney review any MSO offer before you sign.
Franchises
A franchise gives you a brand and a set of systems in exchange for fees and the franchisor's rules. Ellie Mental Health says a new owner receives an established consumer brand and standardized systems for marketing, intake scheduling, client care and operations. It also says its branded practices are independently owned and operated. You own the practice, and it carries the franchise's name. A franchise fits an owner starting from scratch who values a proven brand and playbook over their own name.
Acquisitions and roll-ups
In an acquisition, a larger company buys your practice and decides how it runs afterward. LifeStance Health's FAQ says the practices it partnered with used their own brand names before 2020, and that all of its partners now use the LifeStance Health brand. A sale can pay you for what you built and take the business side off your plate. You give up ownership and, often, your name. It fits an owner who is ready to sell.
Questions to ask before you choose
Ask every option the same six questions, and get the answers in writing.
- Contracts. Whose name and tax ID are on the insurance contracts, and do they stay with me if I leave?
- Brand. Whose name do clients see on the website, the phone line and the statements?
- Clients. If we part ways, do my clients stay with my practice?
- Equity and exit. Do I give up any ownership, and what does leaving cost in notice, fees or re-credentialing?
- The work. Who answers the phone, checks insurance, files claims, works denials and runs payroll?
- What I see. Can I see inquiries, claims and payments myself, or only in a monthly report?
If you're looking for a Headway alternative
If you want a Headway alternative that keeps contracts in your practice's name, you have three routes. You can credential with payers yourself and hire a biller or billing company. You can hire an operations team that manages credentialing in your practice's name and runs billing and the front desk. Or you can keep a platform for some clients while you build your own panels. Headway says its credentialing doesn't affect your existing insurance contracts, so the two can run side by side.
For the detail, read Cortexa vs Headway and Headway, Alma and independent practice.
How Cortexa works with your practice
In the table above, Cortexa is the last row. You keep your brand, your own insurance contracts and your clients. Cortexa is not a network like Headway or Alma and doesn't bill under its own contracts.
We answer your phone line and inquiries on your practice's behalf, and the number stays yours. We verify insurance at intake and book consultations. We file claims, follow up on pending and denied claims, and set up supervisory and incident-to billing under your payer contracts. We manage credentialing for your clinicians, passed through at our actual documented cost, with contracts in your practice's name. Payroll runs on your existing payroll platform.
Practice Analytics is included, so you can see sessions, revenue, caseloads and where each inquiry is in the pipeline. You can check the status of any claim on your dashboard, any time. We agree the exact scope and rate before you start. Clinical decisions, hiring and classification stay with you.
Common questions
What is a practice management company for therapists?
The phrase has two common meanings. Most often it means practice management software, the EHR your staff uses for scheduling, notes and claims, such as SimplePractice or TherapyNotes. The Psychotherapy Action Network also uses it for platforms such as Headway, Alma and Grow Therapy, where clinicians bill through the platform. A third kind of company, an operations team, does the admin work itself under your practice's contracts. Ask which one you're being offered before you compare prices.
Is Headway a practice management company?
PsiAN calls Headway a practice management company, and Headway works as a network platform. Its group practice FAQ says it credentials clinicians with their own type one NPI and bills insurance under Headway's type two NPI. Your practice still enters and confirms sessions in Headway's system. Headway says it keeps a small percentage of session payments and that its credentialing doesn't affect your existing contracts. If you want claims in your practice's name, look at a billing company or an operations team.
What is an MSO in behavioral health?
An MSO, or management services organization, is a separate company that runs a practice's non-clinical work, such as billing, IT, HR and real estate, under a management agreement. Clinicians keep practicing through their own professional entity. Because the MSO provides no clinical care, people who aren't licensed clinicians, including investors, can own it. Healthcare lawyers note that management fees must generally reflect fair market value. Have an attorney read any MSO agreement before you sign it.
Will I keep my insurance contracts?
It depends on the model. With practice management software, a billing company or an operations team like Cortexa, the contracts stay in your practice's name. On a network platform, claims billed through the platform use its contracts, and Grow Therapy says enrollment won't transfer if you leave. In an acquisition, the buyer controls the business. Headway says joining it doesn't affect contracts you already hold, so check which contracts each client is billed under.
What's the difference between practice management software and a practice management service?
Software gives your staff tools. A service gives you people who do the work. Practice management software such as SimplePractice or TherapyNotes handles scheduling, notes, claims and payments, and someone on your team still answers inquiries, works denials and calculates pay. A practice management service does that work for you. With Cortexa, one team runs the front desk, intake, billing, credentialing and payroll, and Practice Analytics shows you sessions, revenue and caseloads.