BHBI Cohort Certification Program
The BHBI Cohort Program is an intensive, expert-led training experience designed for professionals who want mastery—not theory—in behavioral health billing.
Each cohort is strictly limited to five students, ensuring personalized instruction, direct access to subject-matter experts, and real-time application of complex billing concepts across commercial, Medicaid, and government payers.
Cohorts run on specific, scheduled start dates and progress together through a structured curriculum that mirrors real-world billing operations. Students are guided step-by-step through the full behavioral health revenue cycle, including verification of benefits, authorization workflows, coding strategy, claims submission, denials management, payer negotiations, compliance considerations, and operational best practices.
This program is built for individuals who want to:
- Advance into higher-level billing or revenue cycle roles
- Confidently manage or audit Behavioral Health Billing operations
- Launch or scale a Behavioral Health Billing Company
- Operate with the knowledge and credibility expected by treatment centers, payers, and regulators
Graduates leave the cohort with practical expertise, operational confidence, and professional credibility – not just a certificate.
Enrollment is intentionally limited! Each cohort fills quickly and begins on a predetermined date to preserve instructional quality and outcomes.
Course Content
Section 1: Behavioral Health Billing 101 Section 2: Verification Of Benefits / Eligibility
S1 Lesson 1: Introduction to Behavioral Health Billing
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5 Topics
What is behavioral health billing (and why it matters)?
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Where BH services happen (settings & levels of care)
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The behavioral health revenue cycle—end to end
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Forms, files, and “the plumbing” (what you actually touch)
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Career tracks and entrepreneurship
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S1 Lesson 2 — The History of Behavioral Health Billing
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6 Topics
Before Parity (Pre-2008): “Second-Class” Benefits
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2008: The Mental Health Parity and Addiction Equity Act (MHPAEA)
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2010: The Affordable Care Act (ACA) and the Rise of Behavioral Health Coverage
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2016: Parity Extends to Medicaid and CHIP
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2021–2025: From Policy to Enforcement
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How to Use Parity in Daily Billing (The Biller’s Playbook)
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Welcome to The Behavioral Health Billing Institute
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S1 Lesson 3 — Compliance Foundations for Behavioral Health Billing
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6 Topics
HIPAA Administrative Simplification: the “plumbing” of billing
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HIPAA Privacy, Security, and Breach (what billers must do)
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42 CFR Part 2: extra privacy for Substance Use Disorder (SUD) records
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The No Surprises Act (NSA): what behavioral-health billers do
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Daily revenue-cycle workflow with compliance “built in”
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Quick reference toolbox (bookmark or print)
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S1 Lesson 4 — Verification of Benefits (VOB) & Patient Registration
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7 Topics
The Role of VOB in Behavioral Health Billing
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Historical Context: How VOB Became Essential
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Registration Meets Verification
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Standard VOB Workflow
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Core Tools Used in VOB
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Common Pitfalls & Pro Tips
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Career Pathways & Professional Growth
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S1 Lesson 5: Authorizations & Utilization Review (UR)
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8 Topics
Why Authorizations Exist in Behavioral Health
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Key Concepts
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The Authorization Workflow
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Collaboration Between Billers & UR Teams
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Common Pitfalls & How to Avoid Them
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Real-World Example
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Career & Business Impact
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Lesson Summary
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S1 Lesson 6 — Claim Creation & Submission
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10 Topics
The Claim’s Role in the Revenue Cycle
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Claim Types in Behavioral Health
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Required Data for Claim Creation
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Claim Submission Pathways
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Common Claim Errors and Prevention
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Timely Filing Limits (TFL)
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The Claim Lifecycle
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Real-World Case Study
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Career Application
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Lesson Summary
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S1 Lesson 7 — Claim Status & Follow-Up
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8 Topics
Why Claim Follow-Up Matters
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Tools for Claim Status
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Structured Follow-Up Workflow
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Common Payer Delay Tactics & Counter-Strategies
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Tracking Systems & Performance Metrics
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Real-World Case Study
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Career Relevance
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Lesson Summary
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S1 Lesson 8 — Payment Posting & Reconciliation
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9 Topics
Why Payment Posting Matters
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Payment Sources
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Workflow: Posting & Reconciliation
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Understanding EOBs & ERAs
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Best Practices in Payment Posting
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Common Pitfalls
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Real-World Example
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Career Relevance
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Lesson 8 Summary
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S1 Lesson 9 — Denials & Appeals
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8 Topics
Why Denials Happen
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Decoding Denials
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The Appeals Workflow
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Using Laws in Appeals
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Templates for Appeal Letters
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Common Pitfalls in Appeals
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Real-World Example
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Career & Business Relevance
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S1 Lesson 10 — Compliance in Action: Documentation, Audits & Risk Management
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9 Topics
Why Compliance Matters in Behavioral Health Billing
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The Role of Documentation
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Types of Audits
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Responding to Audits
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Fraud, Waste, and Abuse (FWA) Risks in Behavioral Health
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Compliance Programs & the Biller’s Role
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Real-World Example
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Compliance Best Practices Checklist
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Career & Business Relevance
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S1 Lesson 11 — Patient Billing & Collections
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9 Topics
Why Patient Billing Matters
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Sources of Patient Responsibility
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Generating Patient Statements
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Patient Communication Strategies
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Legal and Compliance Framework
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Collections Workflow
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Common Pitfalls
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Real-World Example
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Career & Business Relevance
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S1 Lesson 12 — Advanced Topics: Coordination of Benefits, Secondary Insurance & Complex Scenarios
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8 Topics
Why COB Matters in Behavioral Health
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Determining Primary vs. Secondary Coverage
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Submitting Secondary Claims
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Complex Scenarios
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Common Pitfalls & How to Fix Them
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Real-World Example
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Career & Business Relevance
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Advanced Tips for Professionals
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S2 Lesson 2 — Gathering Essential Information & Conducting Eligibility Verification
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9 Topics
Before You Verify: Building the Foundation
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Where Eligibility Data Comes From
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Step-by-Step: Performing Eligibility Verification
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Recognizing Red Flags During Eligibility
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Common Eligibility Mistakes and How to Fix Them
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Eligibility Verification in Behavioral-Health Context
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Documentation Standards for Eligibility
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Mini-Lab 1 — Portal Practice
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Mini-Lab 2 — Spot the Error
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S2 Lesson 1: Foundations of Verification of Benefits & Eligibility in Behavioral Health
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12 Topics
Understanding the Purpose of Verification of Benefits
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Why VOB Matters in Behavioral Health
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The Life Cycle of a Behavioral-Health Claim
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Key Terminology & Core Concepts
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Real-World Example: The Cost of Missing VOB
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The Verification Mindset: Accuracy Over Speed
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Legal & Ethical Framework
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Core Competencies of an Expert VOB Specialist
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Step-by-Step Overview of the Full VOB Process
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Mini-Lab 1 — Mapping the VOB Workflow
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Mini-Lab 2 — Cost Consequence Calculation
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Summary & Key Takeaways
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Section 1 Knowledge Check
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1 Quiz
Section 1 – Behavioral Health Billing 101 Knowledge Check
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S1 Lesson 13 — The Future of Behavioral Health Billing
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7 Topics
Growing Demand for Behavioral Health Services
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Regulatory Shifts Changing the Landscape
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Technology & AI in Behavioral-Health Billing
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Career & Entrepreneurial Opportunities
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Inspiration — Why This Work Matters
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Preparing for Lifelong Learning
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Closing Thought
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S2 Lesson 3: Behavioral Health Carve-Outs and Network Verification
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13 Topics
First principles
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How to spot the carve-out (three-step method)
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Plan types (what “HMO / PPO / EPO / POS / ASO” mean in real life)
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What “network” really means (and why it’s two checks, not one)
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Levels of care (LOC) don’t always share the same network status
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BlueCard (for BCBS plans across states) — a quick explainer
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Out-of-network reality (what patients and programs need to know)
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Single Case Agreements (SCA) — when and how
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Step-by-step: run a carve-out + network check the right way
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What to document (so you pass any audit)
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Red flags you must catch (and what to do)
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Case studies (walkthroughs you can copy into your LMS)
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Mini-labs
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S2 Lesson 4 — Financial Analysis and Benefit Interpretation in Behavioral-Health Verification of Benefits
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11 Topics
Why Financial Mastery Matters in Behavioral Health VOB
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The Building Blocks of a Financial Profile
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In-Network vs Out-of-Network Financial Dynamics
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Behavioral-Health-Specific Financial Nuances
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Benefit Limits and Exclusions
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Financial Data Collection During VOB
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Calculating Patient Responsibility
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Communicating Financial Findings
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Red-Flag Indicators During Financial Verification
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Documentation Standards (QA Perspective)
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Practice Lab
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S2 Lesson 5 — Limits, Exclusions, and Red-Flag Detection & Escalation
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12 Topics
Why This Lesson Matters
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Understanding the Language: “Limit” vs “Exclusion”
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The Two Types of Limits
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Common Behavioral-Health Service Exclusions
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Facility and Population Restrictions
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Network-Design Limitations
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Recognizing “Red Flags” During VOB
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Escalation Pathways When a Limit or Exclusion Blocks Coverage
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Audit-Proof Documentation Standards
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Communicating Complex Limits to Non-Experts
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Hand-Offs to Other Departments
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Quality-Assurance (QA) Checklist — How to Self-Audit Your VOB
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Final Quizzes
Section 5 Claim Management Knowledge Check
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Section 1 Quiz
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