WELCOME TO PROVIDERS

The Commonwealth's HealthChoices program and the creation of CBH in February 1997 provided all of us with the opportunity to improve and expand mental health and substance abuse services for people in need. Achieving this aim requires a partnership between those managing public resources and those whose clinical expertise and compassion can make a real difference to the lives of Philadelphia's most vulnerable citizens. In pursuing that goal, we remain committed to playing a key role in your success, as you have played a key role in ours. Please contact a CBH Provider Relations representative at (215) 413-7660, if we can be of any assistance.

Provider Alerts

August 21, 2006

Medicare and Medicare Advantage HMO Provider Exceptions Notification

It has come to our attention that some providers within our network are not aware of the changes made around dual eligible members (Medicare/Medicaid).

The DPW Policy Clarification regarding dual eligibles has required CBH to end date Medicare and Medicare Advantage HMO provider exceptions as of 6/30/06. CBH will not cover as primary insurer a service which is covered by Medicare or Medicare Advantage HMO plans. This includes Medicare services where the provider is not enrolled in Medicare or Medicare Advantage HMO plans. CBH is prohibited from paying for a Medicare covered service simply because the provider is not enrolled in Medicare or Medicare Advantage HMO plans. It is incumbent upon the provider to either enroll in Medicare or Medicare Advantage HMO plans, refer the member elsewhere, serve the member at no cost to them, share the cost with the member, or the member may elect to pay out of pocket.

July 5, 2006

Due to apparent problems in the HIPAA parser, electronic claims from June 27,28 and 29 were renamed (with an r at the end of the file name), resubmitted, and readjudicated. This will result in a larger number of rejections than normal for providers, particularly duplicate claims. CBH apologizes for any inconvenience this may cause.

June 2, 2006

Effective July 1, 2006, CBH will no longer accept claim file submissions via diskette. As technology advances, it is increasingly difficult to find systems that accommodate diskettes, necessitating this change. CBH will continue to accept claim file submissions via CD or electronic transmission.

Should you have questions about this change, please contact your Provider Relations Representative at (215) 413-7660.

March 6, 2006

As part of the Department of Behavioral Health's continued process of streamlining and improving the behavioral health system, CBH will be changing the process of communicating the status of authorizations. Effective April 1, 2006, CBH will no longer issue paper authorization letters. At that time, providers will only be able to view authorizations via FTP over the CBH browser. CBH currently mails authorization letters to the providers and posts a report on the FTP server on a weekly basis. Effective April 1, 2006 the authorization reports will be updated and available on a daily basis. This will enable providers to view their authorizations in a more 'real-time' environment. Providers who receive their authorizations verbally directly from the care managers involved with the case will continue to so, in addition to the electronic availability of the authorization reports.

February 13, 2006

There was a typographical error in the first sentence on page 4.17 of the Provider Manual. This error has been corrected. However, if you have previously printed this page, please discard and replace your printed copy with the corrected page.

February 6, 2006

Beginning March 1, 2006, CBH will no longer require authorization numbers for the billing of Level of Care 325-1, Partial Hospitalization for Adults. All other levels of Partial, including Acute and Children's will continue to require prior authorization.

LINKS FOR PROVIDERS

THE COMMONWEALTH OF PENNSYLVANIA

HealthChoices
Program Standards And Requirements

PHYSICAL HEALTH MANAGED CARE ORGANIZATIONS
FORMULARY LISTS

AmeriChoice Health Partners Keystone Mercy

THE PENNSYLVANIA COALITION AGAINST DOMESTIC VIOLENCE

Good and Healthy Relationships
Do your patient's have healthy relationships based on trust and respect or are they caught in abusive relationships? It is important to talk to your patient's about their relationships because living in a stressful environment can have a direct impact on their health.