Welcome to the Providers Page

Frequently Asked Questions

How much detail is expected on treatment plans?
CBHA no longer uses treatment plans in the traditional way to authorize care.  Instead of filling out a form, CBHA requests that you call to discuss the case with a clinical care manager. The clinical care manager will ask you a series of questions to assure that medical necessity for outpatient care is continuing to be met and will authorize care accordingly.  You can find this survey under the Provider tab in the section marked “Provider Forms.”  The form is called Outpatient Services Review.  If you prefer, you may fill out the form and fax it to a Clinical Care Manager (CCM) for processing.  The CCM will call you with any questions.

How many sessions will likely be authorized at one time?
CBHA currently registers 20 sessions for initial requests for psychotherapy.  For physicians and nurse practitioners who are performing medication management functions only, CBHA does not limit the number of sessions or time frame for care.  Physicians do need to have the care registered so that claims may be paid appropriately and care coordinated, as necessary. 

What is the available benefit for ADD/ADHD?
The benefit may vary by plan. Enrollees should call CBHA to determine coverage under their individual plans.

Will CBHA authorize group therapy?
CBHA recognizes that group therapy programs can be beneficial and is willing to authorize these services. We ask providers who conduct group therapy programs to submit a written description of the group(s). It is preferred that groups have defined time limits and be open to newcomers. CBHA does not authorize support groups that are not facilitated by a licensed therapist.

Can an enrollee see a 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 authorization. CBHA will not authorize more than one provider for psychotherapy at any given time, except under extraordinary circumstances. CBHA will, however, cover a psychiatrist to provide one hour of service (90807) even though the member is also seeing a psychotherapist.

Will CBHA allow for more than one family member to be seen by the same therapist?
If it is clinically appropriate for more than one member of a family to be seen by the same therapist, CBHA will support this plan. It is helpful if the provider contacts CBHA clinical case management staff to discuss reasons for the request rather than to simply ask the enrollee to call for an authorization. If several members of the same family require treatment, family therapy may be indicated. If several members of the same family are seeing different therapists, CBHA will likely request clarification why this is necessary and whether the participating providers are collaborating on the case.

Is marital therapy a benefit and if not, why?
Marital therapy is usually not a covered benefit, however, enrollees should be directed to check with CBHA regarding their specific plan.

If an enrollee or provider fails to obtain authorization prior to being seen in treatment, will CBHA backdate?
CBHA will not backdate if pre-authorization is not obtained prior to the provision of services. Failure to obtain prior authorization will result in an administration sanction which is a denial due to failure to follow the provider contract and is not related to medical necessity. (See Administrative Sanction details described in the CBHA Provider Manual .)

Does CBHA authorize long term treatment under certain circumstances?
Long-term therapy is not a covered benefit. CBHA recognizes some enrollees continue to have acute symptoms for extended periods of time and supportive maintenance by a therapist or psychiatrist 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.