Community Mental Health Center and CCBHC Billing

Medtransic bills insurance for community mental health centers and certified community behavioral health clinics (CCBHCs). We send and follow up on Medicaid, Medicare and commercial claims, including partial hospitalization under the center, and we credential and enroll the center and each clinician who bills. We work inside your existing system, such as Qualifacts. Billing is 4-8% of what we collect for you. Credentialing is $150 per application, per provider, and there is no long-term contract.

Last reviewed 2026-10-04.

Where a community center's revenue slips

A center bills under several payment systems at once. Each one has its own rule for who bills, what counts and how the rate is set.

  1. A therapist's claim for a program service

    When a Medicare-certified center runs partial hospitalization or intensive outpatient care, Medicare does not pay its social workers, counselors or family therapists under their own benefit for that work. The center bills. A clinician claim sent for a program day is denied.

  2. Partial hospitalization days without a current certification

    A physician must certify that a Medicare patient needs at least 20 hours a week of partial hospitalization, and recertify at least every 30 days. Days after a lapsed recertification have nothing behind them.

  3. A CCBHC rate built on a weak cost report

    Your state rebases CCBHC rates on cost reports of your costs and visits. If encounters and costs in the claims system do not match what finance reports, the next rate starts from the wrong numbers.

  4. Peer support that does not meet the payer's terms

    Medicaid peer support needs supervision, a plan of care and state-defined training. A peer service billed without them falls short of the federal minimum.

Our part, and your center's part

What we run

What stays with you

Your EHR shows what you billed. Your portal shows what we are doing about it.

Your EHR or practice management system runs your practice, but it does not show you our work. The Medtransic HIPAA Compliant Portal does: every claim and its current stage, the denials we are working, your A/R by age, each payer application and its in-network date, and the documents we still need from you. It is the same record our team works from, and it comes with every client account.

Did that claim get paid?

Every claim with its stage and amount, the denials we're working, and your receivables by age.

Where is my application with Aetna?

Each payer application shows its stage, its history, and the date you can start seeing that payer's patients.

What do you still need from me?

One list of the documents we're waiting on. Upload once, and it reaches every payer that asked for it.

It works in any browser, on your desk or your phone. iPhone and Android apps are coming soon. See the client portal.

What CCBHC status asks of a center, and how it pays

These are federal rules for the CCBHC Medicaid demonstration and for Medicare community mental health centers, current as of October 2026. States add their own rules on top.

The nine services a CCBHC must offer. The statute lists crisis services, including 24-hour mobile crisis teams; screening, assessment and diagnosis; patient-centered treatment planning; outpatient mental health and substance use services; primary care screening and monitoring; targeted case management; psychiatric rehabilitation; peer support, counselor services and family supports; and intensive community-based care for service members and veterans. A clinic may provide some of these through formal relationships with other providers.

Open to everyone who walks in. A CCBHC must use a sliding fee scale. It may not refuse or limit services because of a patient's ability to pay or where they live. It must also report encounter, clinical outcome and quality data.

Four ways a state can pay. Demonstration states choose one of four cost-based, clinic-specific payment methods: a daily rate, a monthly rate, or either one with separate rates for special crisis services. Quality bonus payments are optional under the daily methods and required under the monthly ones, which also require outlier payments. CMS last updated this guidance in February 2024.

One daily payment per person. Under the daily method, a clinic gets at most one payment per person per day. The daily rate is total allowable annual costs divided by annual daily visits. States may not pay anything extra for demonstration services outside the rate, outlier payments and quality bonus payments.

Cost reports and rebasing. Rates are updated each year by the Medicare Economic Index or by rebasing on cost reports. States must rebase for demonstration year 3 using year 2 cost reports, and at least every 3 years after that.

Which states are in the demonstration. Thirty states have been selected in all: 8 original states, 2 added under the CARES Act, and two rounds of 10 under the Bipartisan Safer Communities Act. The second round, Alaska, Colorado, Hawaii, Louisiana, Maryland, Mississippi, Montana, North Dakota, Washington and West Virginia, starts between July 1, 2026 and July 1, 2027.

Medicare's 40% rule. A Medicare community mental health center must give at least 40% of its services to people who are not Medicare beneficiaries. It must also hold state licensing or certification, provide outpatient services and 24-hour emergency care, offer day treatment, partial hospitalization, intensive outpatient or psychosocial rehabilitation, and screen patients for state mental health facility admission.

How Medicare pays partial hospitalization. Medicare pays a center's partial hospitalization under the hospital outpatient payment system, as a daily rate. There is one rate for days with three services and another for days with four or more. For 2026, CMS bases center costs on 40% of hospital-based partial hospitalization costs.

Governance and telehealth. A Medicare center needs a governing body of at least two people, one a mental health clinician, and an administrator who is its own employee. A center can also be a Medicare telehealth originating site, and that site fee does not count toward the services that set a partial hospitalization day's payment.

Enrolling the center and credentialing its clinicians

A center enrolls twice over: once as an organization, then for each clinician who bills under their own number. We build both files and track each application to an effective date.

  1. The center's own enrollment

    Medicare enrollment for the center is filed online in PECOS, Medicare's enrollment system, separately from your state Medicaid enrollment and your commercial contracts. We prepare and file each one.

  2. Clinicians who bill outside the program

    Outpatient therapists, psychiatrists and nurse practitioners who bill under their own numbers each need their own applications. We keep their CAQH profiles complete and attested so commercial applications do not stall.

  3. Peer specialists under your state's rules

    Your state defines peer support training and certification. We collect those records with each peer specialist's file, so the supervision and certification your Medicaid plans expect are on hand.

  4. Effective dates in your client portal

    Every application, its stage and the documents we still need sit in your client portal, included with every client account.

Credentialing is $150 per application, per provider. In our experience it usually takes 60 to 90 days with each payer.

Payer notes for community centers

Medicaid and CCBHC rates

In a demonstration state, CCBHC services are paid at the clinic-specific rate your state set, not a fee per service. We bill the way your state built that rate, and bill other Medicaid services under their own rules.

Medicare

When a center provides partial hospitalization or intensive outpatient care, the center bills it, not its social workers, counselors or family therapists. Medicare pays the center's partial hospitalization as a daily rate.

Medicaid peer support

CMS set the minimum terms in a 2007 letter to state Medicaid directors: supervision by a competent mental health professional as the state defines it, services tied to an individualized plan of care, and state-defined training and certification.

Medicare peer support

Medicare pays for peer support only in a narrow form: principal illness navigation services delivered by peer support specialists under general supervision.

When we are not the right fit

If you run a large multi-site agency with its own billing department that keeps claims clean and paid, you may not need us. We are a better fit for centers whose billing team is small, stretched or about to change.

We do not prepare Medicaid or CCBHC cost reports. That work stays with your finance team or your accountant. We bill, credential and enroll.

Questions community mental health centers ask us

How much does billing for a community mental health center cost?

Billing is 4-8% of what we collect for you, with no long-term contract. Credentialing is $150 per application, per provider. The revenue audit before you sign is free.

Do you prepare our CCBHC cost report?

No. Cost reports stay with your finance team or accountant. We bill, credential and enroll the center and its clinicians.

Can our social workers bill Medicare for partial hospitalization days?

No. When a center provides partial hospitalization or intensive outpatient care, Medicare does not pay social workers, counselors or family therapists under their own benefit for it. The center bills those services.

What is the 40% rule?

A Medicare community mental health center must give at least 40% of its services to people who are not Medicare beneficiaries. It is one of the conditions for being a Medicare center at all.

How often are CCBHC rates rebased?

States update rates each year by the Medicare Economic Index or by rebasing on cost reports. They must rebase for demonstration year 3 using year 2 cost reports, then at least every 3 years.

Which systems do you work in?

We work inside your existing system, including Qualifacts, SimplePractice, TherapyNotes and CentralReach, so your center does not switch software to work with us.

Sources

Outside facts on this page were checked against these sources on the date shown.

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