This manual is a reference and source document for network mental health and substance abuse providers and facilities participating in the CBHA program. It contains all relevant program policies and procedures and accompanying explanations and exhibits.
CHBA views your continued independence, clinical freedom and success as essential to the program's effectiveness. The better each network provider understands the program and the way it is designed, the greater the likelihood of success. This manual is intended to help maximize the value of the program for you and your patients.
This manual is updated as experience with the program, enrollees and network providers dictate. Quality issues are continuously monitored to determine areas needing improvement.
This manual is designed to clarify the various provisions of the Network Professional Agreement you have already signed. It is considered to be a part of that agreement and to operate as a unified whole and does not create new or different requirements. In the event that a conflict is ever found to exist between the provisions of this manual and the agreement, the agreement shall take precedence.
Carolina Behavioral Health Alliance (CBHA) is a managed behavioral health organization based in Winston-Salem, North Carolina and is owned by three North Carolina medical schools-East Carolina University, University of North Carolina Chapel Hill, and Wake Forest University. The mission of CBHA is to assure access and exceptional value in behavioral health services and benefits for its clients. Reflecting the best tradition of academic medicine, we seek effective outcomes provided in a dignified and confidential manner. Our goal is to facilitate and ensure that our members receive the most efficient and effective mental health and chemical dependency treatment available and that their benefits are used wisely. This treatment is facilitated through CBHA's extensive statewide network of community and academic behavioral health providers and facilities.
CBHA is proud of the reputation it has earned in the healthcare community as an organization dedicated to providing superior service to its customers. Amongst enrollees, providers, and benefit administrators, CBHA is known for being one of the friendliest and easiest health plans to work with. This accomplishment is due in large part to:
Simplified, provider-friendly utilization management procedures;
A comprehensive, statewide provider network;
The CBHA commitment is to provide customers with prompt and personal service.
CBHA is a licensed TPA and meets or exceeds all regulatory and NCQA requirements for utilization management. A clinician is available for emergencies 24-hours a day, 7 days a week through a simple call in process to 1-800-475-7900. Enrollees and providers always reach a live person when they contact CBHA; there is never a need to follow a telephone menu or wait through excessive holding times.
The mission of Carolina Behavioral Health Alliance is to assure access and exceptional value in behavioral health services and benefits for its clients. Reflecting the best tradition of academic medicine, we seek effective outcomes provided in a dignified and confidential manner.
The goal of Carolina Behavioral Health Alliance is to facilitate and ensure that our members receive the most efficient and effective mental health and chemical dependency treatment available and that their benefits are used wisely.
Registered CBHA providers can log-on the our website at www.cbhallc.com to review enrollee eligibility, benefits and claims information. A registered CBHA provider can also obtain an initial registration number for outpatient care on-line. To obtain a provider log on and password, please contact CBHA at 1-800-475-7900,
CBHA provides detailed information on our website for our providers and enrollees at www.cbhallc.com . Information on the website is frequently updated to provide current information about behavioral health services. The website includes a Provider Search feature that allows our enrollees to locate providers by name, location and specialty. Documentation forms and the provider manual are located on the website under the Provider section.
| For registration, eligibility or benefit information | 1-800-475-7900 |
| fax 1-336-499-4006 | |
| For professional relations, claims questions and filing information complaints, grievances and appeals | 1-800-475-7900 |
The toll free line is answered by a live person and is staffed after hours for emergencies. Routine authorizations and questions are addressed during normal business hours. |
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| All claims and correspondence should be mailed to: | CBHA PO Box 571137 Winston Salem, NC 27157-1137 |
PROVIDER FREQUENTLY ASKED QUESTIONS
How does the CBHA registration system work?
CBHA paneled providers need to register care for CBHA members in order to be reimbursed by the health plan for services. CBHA will register 20 sessions of psychotherapy in a 12-month timeframe and an unlimited number of medication management sessions for physicians. CBHA registers in-network providers in order to promote coordination of care among treating providers as well as to assure the patient is not receiving concurrent care by two like providers.
What if I need more psychotherapy sessions?
In order to request more psychotherapy sessions after the initial 20, you will need to call a CBHA Clinical Care Manager (CCM) at (800) 475-7900. You and the CCM will discuss the clinical issues that support more psychotherapy sessions, as well as discuss projected conclusion of therapy. In order to monitor and evaluate the quality of patient care, the following aspects of care need to be examined- (1) Is the care appropriate for the condition? (2) Is the care effective (symptom relief)? (3) Is the care cost efficient? (4) Is the care accessible? (5) Is the care safe? and (6) Is the patient satisfied? If the enrollee is not showing improvement, CBHA will pay for and encourages providers to request a second opinion.
Are there services that require pre authorization?
Yes. All intensive levels of services (inpatient, partial, and intensive outpatient programs) must be pre authorized. Psychological and Neuropsychological testing, outpatient consultations, ECT (outpatient and inpatient), extended psychotherapy sessions (90808/90809), behavioral health home visits, Outpatient Suboxone treatment, Gastric Bypass Evaluations and Vagus Nerve Stimulators (VNS) all need pre-authorization.
Is group therapy covered under the initial registration?
Yes, the initial registered visits cover individual as well as group therapy sessions provided by the registered therapist. CBHA will not pay for support groups provided by non-licensed therapists.
Can an enrollee see the same provider more than once in one day?
In rare cases, CBHA will cover a 75-80 minute session, however, we will not cover two sessions in one day for the same therapist.
Can a patient see his/her therapist and a psychiatrist in the same day?
An enrollee may see his/her therapist and psychiatrist in the same day and receive insurance reimbursement if both providers have prior registration. CBHA will not register more than one provider for psychotherapy at any given time, except under extraordinary circumstances.
Is marital therapy a benefit?
Marital therapy is usually not a covered benefit, however, enrollees should be directed to check with CBHA regarding their specific plan.
If an in network provider fails to obtain registration prior to providing treatment, will CBHA backdate?
CBHA will not backdate if pre-registration is not obtained prior to the provision of services. Failure to obtain prior registration will result in an administrative sanction, which is a denial due to failure to follow the provider contract and is not related to medical necessity; however, the patient is held harmless and can only be charged their applicable copay or coinsurance. (See Administrative Sanction details described in the CBHA Provider Manual. ) CBHA does allow a five day grace period to obtain registration.
Does CBHA authorize long-term treatment under certain circumstances?
CBHA recognizes some enrollees continue to have acute symptoms for extended periods of time and supportive maintenance by a therapist will be considered in these cases. The treatment plan for chronic patients must continue to concentrate on acute, short-term goals. CBHA encourages providers to facilitate enrollee involvement in community support groups available in the area as well as building support systems with family, friends, community sponsored activities, co-workers, etc., to help the patient maintain his/her progress when treatment is terminated.
How long does CBHA take to reimburse claims?
CBHA pays all clean claims well within thirty (30) days of receipt. If providers have any concerns/complaints regarding claims payment, they should contact the CBHA Claims Department Manager. CBHA is committed to maintaining a good relationship with its provider network and welcomes information about provider's concerns.
If an enrollee has specific confidentiality concerns, how is this handled by CBHA?
Confidentiality is always a main concern of enrollees, especially if they work within the health systems covered by CBHA. Enrollee information is held in strict confidence by CBHA staff and enrollee records are kept in a secure location and accessible only to those who have "a need to know". If an enrollee requests additional confidentiality protection, CBHA is willing to do whatever is necessary to help the enrollee feel comfortable. Enrollees or providers are welcome to call and discuss these concerns at any time throughout treatment with clinical case management staff.
Will CBHA authorize psychological or neuropsychological testing?
Psychological testing requires pre-authorization. CBHA has a questionnaire, Request for Psychological Testing that must be completed by the provider and submitted to CBHA. CBHA's Consulting Psychologist makes the decision regarding all psychological testing. Most requests for psychological testing are granted based upon a need to clarify a clinical issue or a need to provide direction to treatment planning. Psychological testing for Learning Disabilities is generally not a covered benefit under the behavioral health plan. Talk to a CCM about the details of specific health plans CBHA manages.
Enrollees whose behavioral health benefits are managed by Carolina Behavioral Health Alliance (CBHA) have the right to:
Enrollees whose behavioral health benefits are managed by Carolina Behavioral Health Alliance (CBHA), have the responsibility to:
If you have any questions, please feel free to call CBHA at 1-800-475-7900 or write to us at: P.O. Box 571137, Winston-Salem, NC 27517-1137.