Let’s stop pretending payer relations are a matter of “better provider communication” or “educating your staff on clean claim submission.” No amount of internal workflow optimization fixes the problem we are facing right now: the inability to have real payer conversations with real people who have real authority.

Pre-COVID vs. Post-COVID: Something Fundamentally Shifted

Before COVID, payer reps weren’t perfect, but they were accessible. If a claims issue went off the rails, you could pick up the phone, escalate to a payer rep or provider relations contact, and actually talk through the logic of an edit or denial.

Now?

• Phone trees driven by AI or “call routing logic” that leads nowhere.
• Call centers that can only recite policy text from a script.
• Reps who also lack decision-making authority and are limited to reading “what the system shows.”
• Escalation? Good luck. It’s a black hole.

Let’s be clear: Offshoring isn’t the problem. Poor training and zero empowerment to solve real issues that’s the problem.

Behavioral Health Takes an Even Bigger Hit

Behavioral health billing is already nuanced:

• Licensing restrictions.
• Provider type edits.
• “Incident to” vs “Supervision” variances between Medicare, Commercial Plans and Medicaid.
• Telehealth parity rules that apply to BH differently.
• ASAM medical necessity disputes.
• Payers applying incorrect logic because they don’t understand BH program structures (IOP vs. PHP vs. OP vs. case management vs. CPST/TBS, etc.).

So when a front-line representative has no context for behavioral health billing frameworks and no way to reach someone who does, BH providers are left in a constant denial defense loop.

The Illusion of Partnership

Payers love to use words like “collaboration,” “provider engagement,” and “partnership.” Let’s just call it out: there is nothing collaborative about sending providers through 8 layers of phone menus just to reach someone who can’t act on anything.

If payer relations is truly a partnership, access to a trained payer representative shouldn’t feel like a hostage negotiation for payment.

The Daily Reality for Billing Teams

Ask any revenue cycle team and they’ll tell you:

• Denials labeled as “incorrect provider type” when the provider is 100% credentialed.
• Edits placed on behavioral health codes that don’t even apply to BH provider specialties.
• “Refile the claim” as the default payer response without fixing the underlying logic.
• “System shows no issue” when the claim has clearly rejected from their own system.

If you’ve ever spent 30 minutes explaining a regulation to a payer rep because they don’t know their own rule, you’re not alone.

So What Do We Do?

There are only three workable strategies until the industry wakes up:

1. Identify and Protect Relationships with Actual Decision-Makers

If you have even one payer contact who knows your program guard that relationship. Those become your lifeline when edits go haywire. Don’t overutilize those contacts always try the required process first then tag them when it fails.

2. Document Everything for Leverage

If you can’t escalate through conversation, escalate through documentation.

• Screenshots of incorrect logic.
• Citations of payer policies.
• Internal tracking of repeated erroneous denials.
  This becomes your ammo for provider complaint processes or network advocacy.

3. Stop Accepting “Policy Says...” as a Final Answer

Policy text without interpretation is meaningless. Behavioral health providers need payer reps who understand context. If the representative cannot escalate to someone with behavioral health knowledge, it’s not a complete support process.

Final Thought

Payer relations has become a comedy performance of communication not actual communication. Until payers invest in trained, empowered humans who understand the specialties they serve, billing teams will continue to rely on a brutal combination of persistence, caffeine, and sheer stubbornness to get claims paid. This is why we are all burnt out in this field!!