Mental health verification of benefits checklist

Before the first session

A verification of benefits for therapy is more than confirming a plan is active. These are the questions that decide whether a behavioral health claim gets paid. Use the list as a script for a payer call or a portal check.

1. Member details match the card. Full name, date of birth, member ID, group number, and the subscriber if the client is a dependent.
2. Coverage is active on the date of service. Confirm the effective date and any termination date, especially near January 1 or a job change.
3. Who administers the mental health benefit. Ask whether behavioral health is carved out to another company, such as Optum, Evernorth, Carelon, Lucet or Magellan. If it is, verify with that company. See the carve-out lookup.
4. Network status for the rendering clinician. Check the individual clinician, not only the group, and note any associate or supervised licensure rules.
5. Benefits for the CPT code you will bill. Copay or coinsurance for 90791 and 90837 or 90834, and whether office and telehealth visits differ.
6. Deductible and out-of-pocket. Whether the deductible applies to outpatient mental health, how much is met, and the out-of-pocket maximum.
7. Prior authorization. Whether it is required for outpatient therapy or testing, how to request it, and the number of approved units and expiry date.
8. Visit limits. Any annual session cap and how many sessions have already been used this plan year.
9. Telehealth rules. Coverage for virtual sessions, the place of service code and modifier the plan expects.
10. Claims address or payer ID. Where the claim goes, which is often the carve-out and not the carrier on the card.
11. Reference details. Rep name, date, time and call reference number, or the portal and screen where each answer was found.

Before every session after that

Recheck coverage, remaining visits and authorization dates before each appointment, and fully re-verify every client before their first session of a new plan year. Plan changes in January are the most common cause of February denials.

Where to find the answers

The payer routing library shows where each major payer's behavioral benefit lives, and the provider phone and portal directory lists the lines that reach a person. Portal guides cover Optum Provider Express, Evernorth, Carelon and Lucet WebPass.

If your team would rather not run this list hundreds of times a month, Veriframe does it for every session and writes the answers into your EHR.

Last reviewed November 2026. This checklist is general guidance. Payer requirements vary by plan and employer group, so confirm details with the payer on the date of service.