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 Member Services will help you choose your new provider.
• 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.
• You have the right to get treatment from a provider of your choice. The provider must be in-network with CBH. If you are currently in treatment and want a new provider, you can select a new provider at any time. Before you consider finding a new provider, if you are comfortable, please talk to your current provider about your concerns. Your current provider may be able to help you with your concerns.
• If you still want to see a new provider and would like help finding one, please contact CBH Member Services. Once you have an appointment scheduled with a new provider, please cancel your appointments with your old provider. Your current provider can help you transfer your medical records to the new provider. This cannot be done without your permission. Contact your provider for information on their medical records policy.

Office Visits

Making an Appointment with Your Provider

You may contact the provider directly to set up an intake appointment. The provider will work with you to decide the kind of treatment that best meets your needs. You can access many outpatient services without prior approval from CBH. If it is medically necessary, your provider may suggest a service that requires prior authorization from CBH. If you need prior authorization, your provider will make the request to CBH.

If you need help making an appointment with a provider, you can contact CBH Member Services. Our staff will help you with your request.

If you are in a life-threatening emergency situation, please call 911 or go to your local emergency room.

If you need special help getting transportation to a mental health or substance use appointment or program, 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 1 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 behavioral health problems 24 hours a day, seven days a week.

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.

Your provider is responsible for asking CBH for prior authorization. CBH will review the provider’s request, and your service will be approved if your needs meet the medical necessity criteria for that service. If CBH denies the request for service(s), a letter will be sent explaining the decision, and those services will not be approved for payment.

Prior authorizations for urgent services can be requested 24 hours per day. CBH will call your provider to let them know if the request was approved or denied within 24 hours of the request.

Prior authorizations for non-urgent services are processed during normal business hours. When a non-urgent service request is received outside of business hours, the request is marked as received on the next business day. CBH will make a decision about non-urgent service requests within two business days of receiving the request.

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

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

What Does Medical Necessity Criteria 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 of someone the same age.

If you need any help understanding when a service or medicine is medically necessary or would like more information, 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?

CBH does not pay for medication. Medications, including medications you take for your behavioral health, are covered by your Physical Health Managed Care Organization (PH-MCO). Please refer to your PH-MCO to find out which medications are covered.

Please refer to the Covered Services Listing to see which services require prior authorization.

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. See the Complaints and Grievances section of the website for more detailed information.