Behavioral Health Provider Information

CBH wants to make sure that you can get the right help for your mental health and substance use needs. You can receive treatment from individual therapists, group practices, or agencies that are part of our provider network. We will help you find a provider who lives near you and offers the services you need.

To find an in-network provider, you can either contact CBH Member Services or visit our online Provider Directory.

Choosing or Changing Your Provider

You can choose the providers you see.

• If you are starting a new service, changing the care you get, or want to change a provider for any reason, CBH will help you choose your new provider. Contact CBH Member Services for help.
• If you are a new member of CBH and you are currently getting services, you may need to start getting your services from a provider in our network. If your current provider is enrolled in the Pennsylvania Medical Assistance Program but not in CBH’s network, you can continue to get your services from your current provider for up to 60 days. CBH will pay your provider for these services. If your current provider is not enrolled in the Pennsylvania Medical Assistance Program, CBH will not pay for services you receive from your provider. If you need help finding a provider in CBH’s network, contact CBH Member Services.
• There may be times when a provider leaves CBH’s network. For example, a provider could close or move. When a provider you are receiving services from leaves CBH’s network, you will be notified. If the provider is enrolled in the Pennsylvania Medical Assistance Program, you can continue to get your services from the provider for up to 60 days. You will also need to choose a new provider.

Office Visits

Making an Appointment with Your Provider

To make an appointment with your provider, call your provider’s office. If you need help making an appointment, please contact CBH Member Services.

If you need help getting to your provider’s appointment, please tell your counselor, contact ModivCare, or call the Pennsylvania Medicaid contact at 877-835-7412 for transportation assistance.

Appointment Standards

CBH providers must provide services within one hour for emergencies, within 24 hours for urgent situations, and within seven days for routine appointments and specialty referrals. Emergencies are situations that are so severe that a reasonable person with no medical training would believe that there is an immediate risk to a person’s life or long-term health. An urgent condition is an illness or condition which if not treated within 24 hours could rapidly become a crisis or emergency.

For your first visit:

• You will need to bring an up-to-date state ID and insurance card.
• Be prepared to share information about any medical and/or behavioral conditions you may have. It is ok to ask why you are being asked certain questions and how your information will be used.
• Bring a list of current and past medications.
• Plan to arrive 15-20 minutes early. Check with your provider about lateness policies. Some providers may not be able to see you if you are late.
• If you have to cancel your appointment, please give your provider at least 24 hours notice.
• If you missed your appointment, call your provider as soon as possible to reschedule.

After Hours Care

You can contact CBH Member Services for non-emergency medical problems 24 hours a day, 7 days a week. On-call health care professionals will help you with any care and treatment you need.

Second Opinions

You have the right to ask for a second opinion if you are not sure about any medical treatment or service that is suggested for you. A second opinion may give you more information that can help you make important decisions about your treatment. A second opinion is available to you at no cost.

Contact CBH Member Services to ask for the name of another CBH network provider to get a second opinion. If there are not any other providers in CBH’s network, you may ask CBH for approval to get a second opinion from an out-of-network provider.

Prior Authorization

Some services need approval from CBH before you can get the service. This is called Prior Authorization. For services that need prior authorization, CBH decides whether a requested service is medically necessary before you get the service. You or your provider must make a request to CBH for approval before you get the service. The following pages show the authorization requirements for a variety of services.

What Does Medically Necessary Mean?

“Medically necessary” means that a service or medicine does one of the following:

• It will, or is reasonably expected to, prevent an illness, condition, or disability.
• It will, or is reasonably expected to, reduce or improve the physical, mental, or developmental effects of an illness, condition, injury or disability.
• It will help you to get or keep the ability to perform daily tasks, taking into consideration both your abilities and the abilities or someone of the same age.

If you need any help understanding when a service or medicine is medically necessary or would like more information, please contact CBH Member Services.

How to Ask for Prior Authorization

Some CBH services may require a prior authorization. A prior authorization means that both your provider and CBH must approve the services before you can receive them. Your provider is responsible for asking CBH for the prior authorization. CBH will review the provider’s request, and your service will be approved if your needs meet the medical necessity criteria (MNC) for that service. MNC refers to a list of symptoms and circumstances that make a service “medically necessary” for your health. This helps to ensure you receive services that are right for you and in the right amount. If CBH denies the request for service(s), we will send a letter explaining the decision, and those services will not be approved for payment.

If you need help to better understand the prior authorization process, talk to your service provider or contact CBH Member Services.

If you or your provider would like a copy of the medical necessity guidelines or other rules that were used to decide your prior authorization request, please visit our listing of Medical Necessity Criteria.

What Services or Medicines Need to Be Prior Authorized?

See the charts in the Covered Services for Adults and for Children and Adolescents sections in the Member Handbook to see which services require prior authorization.

If you or your provider is unsure about whether a service requires prior authorization, contact CBH Member Services.

Prior Authorization of a Service

CBH will review the prior authorization request and the information you or your provider submitted. CBH will tell you of its decision within two business days of the date it received the request if it has enough information to decide if the service is medically necessary.

If CBH does not have enough information to decide the request, it must tell your provider within 48 hours of receiving the request that it needs more information to decide the request and allow 14 days for the provider to give it more information. CBH will tell you of its decision within two business days after it receives the additional information.

You and your provider will get a written notice telling you if the request is approved or denied and, if it was denied, the reason it was denied.

What If I Receive a Denial Notice?

If CBH denies a request for a service or does not approve it as requested, you can file a Complaint or a Grievance. If you file a Complaint or Grievance for denial of an ongoing service, CBH must authorize the service until the Complaint or Grievance is resolved. For more detailed information, see the Complaints and Grievances section of the website.