Filing a Claim for Services by an Out-of-Network Provider
If you receive covered services from a provider who is not in the CBHA network, you may receive benefits for these services if (1) the provider is licensed to provide the service and (2) your plan provides out-of-network benefits. You may file a claim for out-of-network benefits using one of the following methods:
Ask the out-of-network provider to file a claim on your behalf. Available benefits may be paid to the out-of-network provider and you will owe any deductibles, co-pays, coinsurance plus the difference between the CBHA rate for the service and the total charge. If the out-of-network provider requires payment up front from you, the claim may be filed to pay available benefits directly to you.
Complete the first page of a
CBHA Members Claim Form
Form and ask the out-of-network provider to complete the second page of the form. Available benefits will be paid directly to you.
CBHA Members Claim Form
and attach a super-bill or other documentation provided by the out-of-network provider which contains complete
billing information concerning the service.
Whichever claim filing method you choose, the following information must be included in the claim submission in order for processing to be completed:
The name, address and license of the provider of service
The date(s) of service
The procedure (CPT) code of the service rendered
The diagnosis or diagnoses relevant to the service rendered
The total amount of the charge for the service rendered
You may telephone the CBHA claims department at 1-800-475-7900 Monday-Friday from
8:30am until 5:00pm for assistance in filing your out-of-network claims. If claim materials received contain incomplete or invalid information, the materials will be returned to you with a notice of required information. Rather than have payment of benefits delayed, if you are unsure of the information that is needed, contact a CBHA claims representative for assistance.
Claims may be mailed to: Carolina Behavioral Health Alliance, LLC, PO Box 571137, Winston-Salem, NC 27157-1137 or faxed to 888-908-7140, Attn Claims Department.
Instructions on uploading your claim
Complete information page with your email address, home address and the name of your employer
Copy your file (s) into the page. The file(s) will now appear within the loading dock.
Your file will move to the header section and a status icon will appear indicating that your document has been uploaded.
Success! If, all required information is on the document your claim should process within 10 business days.