For most behavioral health practices, the start of a new year usually brings more stress than “fresh starts.”
Between high-deductible plans resetting and the constant shift in insurance rates, Q1 is often a period of financial instability. If you feel like you’re working twice as hard just to keep cash flow steady, you aren’t alone.
This guide is a technical blueprint designed to help you hit a 95% revenue effectiveness goal while keeping your administrative sanity intact.
January isn’t just about checking rates anymore; it’s about figuring out who is actually responsible for paying your claims. In 2026, many clinicians are running into a “subcontractor labyrinth.” This happens when major commercial payers outsource specific plans or shift administration, and your “same insurance” client shows up with different routing rules than last year.
Patients also don’t always realize what changed during Open Enrollment – especially if they’re juggling plan notices, new cards, and deductible resets. If you want a clean start to Q1, it helps to anchor your intake workflow to the enrollment calendar:
Use the framework below to build an internal fee schedule. This keeps your team on the same page and reduces “click fatigue.”
|
Payer Name |
Network Status |
Rate (90837) |
Auth Required? |
2026 Requirements |
|
Optum |
In-Network |
~$103.00* |
No |
NPI/Taxonomy Validation |
|
Kaiser (Associate) |
In-Network |
~$140.00 |
Yes |
85% of Physician Fee |
|
Medicare |
In-Network |
~$158.00** |
No |
LMHC/LMFT @ 75% |
|
WA Apple Health |
In-Network |
HB 1392 Enhanced |
No |
Updated Associate Taxonomy |
* Example regional adjustment (commercial rates vary by contract and region).
** Reference point only; see CMS CY 2026 MPFS policy details: CMS CY 2026 PFS final rule fact sheet.
By January, many clients feel a real cost shock: deductibles reset, coinsurance kicks in, and a “normal” session can suddenly feel unaffordable. We call this “Deductible Ghosting” – when clients drop out of care because the out-of-pocket math changes overnight.
To keep this grounded in reality (and easier to explain to clients), it helps to reference the bigger cost-sharing picture. KFF’s annual employer survey is a useful benchmark for how common deductibles are and how large they can feel in practice.
The best prevention is to make financial transparency part of your clinical container:
The Q1 admin load is heavy enough without new regulatory requirements. If you serve Apple Health clients in Washington State, taxonomy accuracy matters because it’s a common “silent denial” trigger – especially when associate-level credentials are involved.
Washington HCA issued updated guidance for associate taxonomies, with a transition deadline that ran through the end of 2025 – meaning this is squarely a 2026 “must be correct” item.
Use these exact codes on claims/encounters when applicable:
Your infrastructure should support the human side of your practice, not detract from it. Instead of spending weekends in payer portals, consider tooling that checks eligibility up front and scrubs claim data before submission.
With Juno, a digital admin assistant for your practice, you can perform real-time verification so you can address high deductibles with your patients upfront, preserving the therapeutic relationship. Juno also handles full-service billing–including claim submissions that automatically scrub for the new 2026 HCA taxonomy codes and license-level modifiers.
A sustainable practice is one that proactively removes friction. When you reduce eligibility surprises, normalize deductible conversations, and keep taxonomy details clean, your practice runs with fewer revenue shocks – and your team spends less time on rework.
If you’d like a second set of eyes on your workflow, you can book a quick demo/consult below.
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