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Frequently Asked Questions

What services require authorization?
Services other than standard outpatient psychotherapy and medication management require pre-authorization. This includes: psychological and neuropsychological testing; EMDR; outpatient consultations; ECT (both outpatient and inpatient); behavioral health home visits; Gastric Bypass Evaluations and Vagus Nerve Stimulators (VNS). Additionally, all intensive levels of services (i.e., inpatient, partial and intensive outpatient programs) must be pre-registered. Call 1-800-475-7900 to speak with a clinical case manager to obtain registration for these services.


Fax (888) 908-7140
Mail: PO Box 571137
Winston-Salem, NC 27157

How do I obtain authorization for psychological and/or neuropsychological testing?
Call CBHA to obtain authorization for consult visits so an evaluation can be done in order to determine what type of testing will be necessary. Prior to administering any testing, the provider should access the CBHA website, www.cbhallc.com, and obtain a copy of the "Psych Testing Request"? form which can be located by clicking on, "Providers", then "Provider Forms".? The form should then be submitted via fax (888) 908-7140), or via mail (PO Box 571137, Winston-Salem, NC 27157).
Upon receipt of the testing request form, a consulting psychologist reviews and renders a decision to the request within three business days. Most requests for testing are granted based upon a need to clarify a clinical issue or a need to provide direction for treatment planning. Please keep in mind, testing for Learning and Developmental Disabilities are generally not eligible under the behavioral health plan; call to obtain details of specific health plans managed by CBHA.

Will CBHA authorize group therapy? -OR- Is group therapy covered under an outpatient psychotherapy registration?
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 clear objectives of a clnical nature (not educational) defined time limits and are open to newcomers. Health plans managed by CBHA do not cover support groups that are not facilitated by a licensed therapist.
Authorization of group therapy is only required if the member is seeing a different therapists for individual and group therapy. If the same provider is seeing the member for both services, a separate authorization is not required.

Can an enrollee see a provider more than once in one day?
We will not cover two sessions in one day for the same therapist. A provider may utilize add on codes, as appropriate, to describe services rendered.

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 for medically necessary treatment and receive insurance coverage.

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. 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 covered benefit?
Treatment of relationship problems where no other diagnosis exists is not covered by CBHA managed benefits.
Do CBHA managed benefits cover VNS and rTMS therapies?
CBHA managed health plans do cover Vagus Nerve Stimulators (VNS) and Repetitive Transcranial Magnetic Stimulation (rTMS) for treatment of certain mental health conditions. You will need to obtain separate prior approval for these treatments. Call CBHA at (800) 475-7900 for details.

If a network provider fails to obtain authorization prior to providing services that require authorization, will CBHA backdate that authorization?
CBHA will not backdate for services requiring pre-authorization that is not obtained prior to the provision of services. Remember, the patient cannot be held liable for the payment of services for lack of authorization; enrollees are only responsible for their co-pay or coinsurance. If a provider is unable to obtain pre-authorization due to extenuating circumstances, they may contact CBHA to discuss the issue. CBHA does allow a five business-day grace period to obtain authorization of care for outpatient services that require prior approval.

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?
Enrollee confidentiality is very important to 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 needs additional confidentiality protection, they must put their requests in writing to CBHA. CBHA will consider all such requests, especially where member safety is an issue.


 

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