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Frequently Asked Questions

How much detail is expected on treatment plans?
CBHA has streamlined its Treatment Plan Update & Request for Service (OTR) to allow providers to share relevant information with minimal time to complete. The treatment plan is designed to be outcomes oriented, rather than process oriented. CBHA clinical case managers are looking for improvement in overall well being of the member in optimal time frames. It is important to remember that treatment must be medically necessary and the majority of clinical information CBHA receives comes from the provider via the OTR. 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. 

How many sessions will likely be authorized at one time?
This depends on the clinical picture of the patient, the amount of detail on the treatment plan and how often the patient is being seen. CBHA generally prefers to update clinical information on therapy cases every three to four months and at least yearly for medication management cases.

Is CBHA willing to flex a patient's benefit?
Under certain circumstances, CBHA will consider flexing an enrollee’s benefits if clinically appropriate. Criteria to determine the appropriateness of flexing the benefit has been developed and each case is reviewed by the CBHA Medical Director. In order to determine justification for benefit conversion, the provider must complete the Benefit Conversion Justification Request. Benefits can only be flexed for enrollees in treatment with in-network providers.

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.