Claims Submission

Welcome to the Claims Submission Page

  • Member Claim Information for Out-of-Network Providers
    • Out of Network Provider requirements:
      • Provider must be fully licensed
      • Your plan must have Out of Network Benefits
  • Complete page one and either attach super bill from provider or ask the provider to fill out page two.
  • Payments can either be sent directly to member or to provider depending on providers preference. Leave box 13 blank to receive payment.
  • Call CBHA claims department at 1-800-475-7900 Monday-Friday from 8:30-5:00 pm for assistance in filling out form.

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