MICRA-BEV™ Explainer · 05 of 05

BEV Report Breakdown

Walk through every field in the MICRA-BEV structured benefit report — purpose-built for behavioral health billing accuracy.

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Benefit Verification Report
BCBS of CT · PPO · Active
SJ
Sarah M. Johnson
DOB: 04/15/1988 · ID: XGH-8827419-01
Deductible
$500 · $113 remaining
Copay
$25 / session
Coinsurance
20% after deductible
Telehealth Parity
✓ Same as in-office
Session Limits
Unlimited (MH parity)
Prior Authorization
Not required
COB / Dual Coverage
None detected

Deductible

$113
remaining of $500 annual

MICRA-BEV parses the deductible separately for Individual and Family buckets. This patient has met $387 of her $500 individual deductible. The remaining $113 applies to claims before coinsurance kicks in.

Why this matters for BH: Many behavioral health claims hit after the deductible is partially met from medical services. Knowing the exact remaining amount prevents surprise patient balances and enables accurate cost estimates before the session.

Copay

$25
per session · CPT 90837

The per-session copay for individual psychotherapy (CPT 90837, 53+ minutes). MICRA-BEV extracts copay amounts per CPT code — not just a single generic copay — because different service codes often carry different patient responsibility.

Collected at time of service: With the copay known pre-session, front desk staff can collect the exact amount before the appointment begins. No more "we'll bill you later" — which has an average collection rate of only 40%.
90791 — $25 90837 — $25 90847 — $40

Coinsurance

20%
patient responsibility after deductible

After the deductible is met, the patient pays 20% of the allowed amount. MICRA-BEV auto-calculates the estimated patient cost using your contracted rate for each CPT code.

Example cost estimate: If your contracted rate for 90837 is $150, the patient's coinsurance portion would be $150 × 20% = $30 per session after deductible. MICRA-BEV surfaces this calculation automatically in the report.

Telehealth Parity

Telehealth Parity Confirmed

MICRA-BEV explicitly surfaces the telehealth parity flag — whether telehealth sessions are covered at the same rate as in-office visits. This is critical for CPT 90837 billing accuracy, where some plans still differentiate.

Why MICRA-BEV flags this: Telehealth coverage varies dramatically by payer and state. Some plans cover telehealth at a lower reimbursement rate, apply different copays, or require place-of-service modifiers. Knowing this before the session prevents billing errors and ensures the provider chooses the right POS code.

Coverage type is broken out separately for in-office and telehealth in the report. If a payer does not cover telehealth for BH, the report flags it with a warning banner.

Session Limits

Unlimited Sessions Mental Health Parity Act

MICRA-BEV's BH-specialized 271 parser catches session-limit data — a field that most standard parsers skip entirely. When session limits are unlimited due to Mental Health Parity, the report explicitly flags this.

The hidden field: Session limits live in the EB (Eligibility Benefit) segment of the 271 at the service-type level. Generic parsers often skip BH-specific service types (STC 30, A7, A8). MICRA-BEV parses all BH service types and surfaces any quantitative limits or unlimited flags.

If a plan does impose session limits (e.g., 20 BH visits per year), the report shows sessions used and remaining — so the provider knows exactly where the patient stands.

Prior Authorization

Not Required (90791) Not Required (90837)

The PA-required indicator surfaces as a warning banner when authorization is needed — along with the payer's auth phone number and portal URL. This prevents claim submission without required authorization, which is one of the top denial reasons in behavioral health.

When PA IS required: The report displays a red warning banner with the payer's authorization phone number, the auth portal URL, and the specific CPT codes that require it. This prevents the #1 preventable denial in BH billing — submitting claims without prior auth.

COB / Dual Coverage

No Dual Coverage Detected

MICRA-BEV parses the OI (Other Insurance) segments in the 271 response for coordination of benefits. When Insurance Discovery finds multiple active hits, dual coverage is flagged with primacy determination — which plan is primary and which is secondary.

When dual coverage IS detected: The report flags both payers, surfaces the primacy order, and notes whether the secondary plan requires its own prior authorization. Billing staff can then submit to the primary first and waterfall the remaining balance to the secondary — maximizing total reimbursement.

COB detection happens automatically during both card-present verification (from the 271 OI segments) and Insurance Discovery (when multiple payers return active coverage).