Qualifacts Billing Services
Yes, we work in Qualifacts. For behavioural health organisations running it, here is what we handle and what stays with your team.
What does not change
- You keep Qualifacts and everything configured in it.
- Your clinicians document exactly as they do now.
- Your programme structure and reporting setup are untouched.
- Your data stays yours. Nothing of yours leaves with us if you go.
What we run inside your Qualifacts
Claims from your existing documentation
We work from what your clinicians already complete. Nothing is submitted before the note supports it.
Medicaid and managed care claims
Behavioural health organisations usually bill more Medicaid and MCO volume than commercial, and the rules differ by state and by plan.
Authorisations tracked across programmes
Where a client receives more than one service, authorisations run down independently. We track them rather than discovering the limit after the fact.
Denials appealed with the cause recorded
Every denial gets a reason logged so recurring ones get fixed at source.
A/R worked in age order
Oldest first, because those claims are closest to their filing deadlines.
How the switch works
We review your recent claims
A sample of what you have been submitting shows what is denying and why, before anything changes.
Access, not migration
You give us user access to the Qualifacts you already run. Nothing moves.
We confirm enrolment across your clinicians
Organisations with staff turnover carry enrolment gaps almost by default. We check before submitting on anyone’s behalf.
New claims start immediately
Current work comes to us straight away so nothing stalls.
Then the backlog
Outstanding claims get worked, oldest and largest first.
What your staff still do
- Document services as they do today.
- Schedule clients and manage programme intake.
- Tell us when a client’s coverage or programme changes.
- Answer anything a payer needs the treating clinician to confirm.
Where practices like yours lose money
Mixed funding makes the billing harder than the volume suggests
Insurance, Medicaid, managed care and contract or grant funding often sit side by side, sometimes for the same client. Which pot a service belongs to is a billing decision before it is an accounting one.
Staff turnover creates enrolment gaps by default
Where clinicians join and leave regularly, enrolment is perpetually catching up. Services get delivered by someone not yet enrolled, and the claims deny long after the work was done.
One client, several services, several authorisations
A client in more than one programme has authorisations running down at different rates. Missing one denies a block of already-delivered sessions.
Questions we get asked
- Do you actually work in Qualifacts?
- Yes. It is among the systems we bill in.
- Do we have to change systems?
- No. We work inside the Qualifacts you already have.
- Can you handle Medicaid and managed care alongside commercial?
- Yes, and for most behavioural health organisations that is the bulk of the volume. Rules differ by state and by plan, which is exactly why it is worth having someone whose job it is to track them.
- What access do you need?
- User access with billing permissions, plus the payer portals you are enrolled with. Your organisation stays the account owner.
- What does it cost?
- Billing is 4-8% of collections depending on volume and specialty. Credentialing is per application, per provider. All rates are on our pricing page.