Welcome to the Member Eligibility
The CBHA claims department is dedicated to paying claims quickly and accurately and providing a clear explanation of claims status. A claims examiner is available to provide a prompt and courteous response to claims inquiries. CBHA claims examiners are trained and willing to consult with providers concerning any billing issues that may deny or delay reimbursement. You may call 1-800-475-7900, Monday through Friday from 8:30 am to 5:00 pm to reach a representative without going through phone prompts or being routed to voicemail.
CBHA network providers, by contractual agreement, must submit claims, including claims with corrected information, within 180 days of the date of service. Providers are advised to file in a timely manner. If claims are denied or paid based on incorrect information submitted on the claim, the provider has 180 days from the date of service to submit a corrected claim.
Paper claims, both CMS-1500 and UB-04 claims, are accepted by CBHA. The mailing address for paper claims: CBHA, PO Box 571137, Winston-Salem, NC 27157-1137.
or click this link to send a scanned claim document Send a Claim File
Claims may be submitted electronically through the CBHA clearinghouse, Claimsnet. Go to the Claimsnet website, http://www.claimsnet.com/cbha, click register at the bottom of the page. A representative from Claimsnet will contact you to provide a routing number if your electronic billing software has established connectivity with Claimsnet. If you use billing software that has no established connectivity with Claimsnet, Claimsnet will assist you in establishing routing by which you can submit electronic claims to CBHA, at no cost to you
Claims Processed by CBHA
To avoid delays in processing, it is important to route only behavioral health claims to CBHA.
- CBHA processes claims for services rendered by behavioral health providers for behavioral health diagnoses.
- Claims for services rendered by medical providers are processed by the medical claims administrator of the plan.
- Claims for services rendered for a medical diagnosis are processed by the medical claims administrator of the plan.
In order for a claim to be processed fully, the claim must contain all required patient, provider and service information in readable form.
- Patient Information: Claims must contain correct patient name, address, birth-date and Plan ID number.Other insurance identifying information must be included on the claim, if known. The patient gender and relationship to the primary insured should also be included on the claim form. For professional services billed on a CMS-1500 form, FL 12 must indicate “signature on file” to evidence HIPAA requirements for release of information.
- Provider Information: Claims must contain the correct provider name, licensure/certification/degree, payment address, Tax ID number, NPI number and phone number. If professional charges are being filed on a CMS-1500 form, the location and address where services were rendered must be entered in FL 32 if different from the payment address in FL 33. For CMS-1500 forms, FL 31 must contain the name of the provider who rendered the service and a signature (or facsimile) attesting that the services billed are valid.
- Service Information: For each service billed, the claim must contain the dates the service was rendered, diagnosis codes or codes pertaining to the service, the procedure code, units of service and the dollar amount charged. For professional services billed on a CMS-1500 form, the appropriate code for the place of service must be entered on the claim form. For facility billing on a UB-04 form, the appropriate code for the type of service must be entered on the claim form.
If another insurance is primary to the plan benefit processed by CBHA, file the primary insurance first. Attach the payment or denial remittance statement from the primary insurance to the claim then filed to CBHA. CBHA will extend the filing time limit beyond 180 days from date of service for co-ordination of benefit claims, but not longer than 60 days from the date on the primary remittance. In no event will the filing time limit be extended beyond 18 months.
Steering toward Successful Claims
Tips for Claims Filing
V Codes will be denied. Services for V codes are outside benefit reimbursement and are billable to the patient.
Charges for missed appointments will be denied. The patient may be billed for missed appointments
A primary diagnosis code of 799.9 (diagnosis deferred) will be denied for all services with the exception of a prior-authorized initial evaluation.
Two sessions of psychotherapy on the same day are not covered. One session will be denied.
Medication management by a psychiatrist and psychotherapy by a therapist on the same day are allowed. Both services will be reimbursed if all other benefit and eligibility provisions are met.
If a claim is submitted with a payment address, physical location or Tax ID number that is different from the information entered in the CBHA provider eligibility file, processing of the claim may be delayed. Always notify CBHA if you change location, payment address or TAX ID number. Your provider file will be updated and future claims processed without delay.