The short answer
Most therapy claim problems come from eligibility, authorization, coding, other-insurance, or data errors, and most are fixable. Check status before resubmitting, correct and resubmit rejected claims, and appeal true denials with records. In solo practice, the cash-flow hit is yours; in other settings, the contract decides.
Why do therapy claims get denied or delayed?
Most often for administrative reasons, not clinical ones:
- Eligibility: coverage wasn't active, or the client's plan changed.
- Authorization: the service wasn't approved, or fell outside approved dates or visits.
- Coding: a CPT code, modifier, or place-of-service code doesn't match the service or telehealth rules.
- Other insurance: the payer thinks another plan should pay first.
- Data mismatches: name, date of birth, member ID, or NPI doesn't match the payer's records.
- Timely filing: the claim was sent too late.
- Duplicates: a claim was resubmitted while the first was still pending.
- Medical necessity: the payer wants more documentation.
Rejected or denied: what's the difference?
A rejected claim never entered processing, usually because of a data error. Fix it and resubmit. A denied claim was processed and not paid. That needs a corrected claim, a reconsideration, or an appeal, depending on the reason. VA's provider claims page uses the same distinction for Community Care.
What should you do when a claim is denied?
- Read the remittance codes. They tell you why.
- Fix the root cause, not just the claim. If eligibility was wrong, check your intake process.
- Correct or appeal within the payer's deadline, with records if medical necessity is the issue.
- Track it until it's paid or closed.
How do delays affect cash flow?
In solo practice, directly. You've done the work and paid your overhead, and the money arrives weeks or months later, or not at all. A few stuck claims can make a month tight. That's why many therapists keep a cash cushion or avoid payers with a history of slow payment.
Who carries the risk?
| Setting | Who absorbs denials and delays |
|---|---|
| Solo practice | You |
| Group practice paying per session delivered | The practice |
| Group practice paying on collections | You |
| Network or platform | Depends on the contract |
Ask directly before signing: "If a claim is denied, am I still paid for that session?"
How ValorWell handles this
ValorWell carries the claims risk. You're paid weekly for each session you documented during that pay period. If a claim is denied, ValorWell handles it, and you don't feel the impact in your pay.
If a documentation issue is behind a problem, ValorWell's first step is to see what adjustment to its system or added support would help. The assumption is that its therapists are doing excellent work.
Important limits
- Pay is for sessions held and documented. It's not for sessions that didn't happen.
- Accurate notes still matter. They're the foundation of clean claims.
- Payer rules differ. For program-specific issues, see Why VA Community Care and CHAMPVA Payments Get Delayed.