Mental Health Carve-Out

Flags a client's insurance policy as a "Mental Health Carve-Out" — when their behavioral health benefits are administered by a separate payer from their primary medical insurance — right from the standard insurance Plan Type field.

Built by Core Engineering

Billing

The problem it solves

Behavioral health practices often need to bill a different payer than a patient's primary medical insurer, since many health plans carve out mental health and substance use benefits to a separate managed behavioral health organization. Without a way to flag this in the patient's record, practices risk losing track of which policy actually governs behavioral health claims.

What's included

"Mental Health Carve-Out" option in the insurance policy Plan Type dropdown, alongside Primary, Secondary, and Inactive
Available when adding or editing a client's insurance policy in the Insurance Form
CMS 1500 claims prefill using the carve-out policy under the same rules as any other policy type
Usable as a secondary claim policy where appropriate
No separate claim-routing or clearinghouse logic — this is a designation, not a new billing pathway

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How it works

On a client's Insurance tab, staff select "Mental Health Carve-Out" from the Plan Type dropdown when adding or editing a policy. This is now a standard option available to all organizations. The designation doesn't change CMS 1500 prefill logic — claims still prefill using the policy from the client's most recent claim, or the first policy on file if there's no history, exactly as with any other plan type.

Mental Health Carve-Out lets practices flag a client's insurance policy as carved out to a separate behavioral health payer, right from the standard Plan Type field. It's for practices whose patients' mental health benefits are administered separately from their medical coverage, and it's available to all organizations as a standard plan type option. The designation doesn't introduce separate claim-routing logic — CMS 1500 claims still prefill using Healthie's existing policy-selection rules.