CBH Call Guide & Benefit Questions
When using DG and you're at the Customer Service Production menu, which option do you enter to find coordination of benefits?
What is Option 17, Member COB Maintenance
Who does a non-tier 1 provider connect with to negotiate rates?
What is an OP Contract Negotiator
What benefit bucket does 0369T fall under?
What is Applied Behavioral Analysis (ABA) MH
What is the number for OCST?
What is 877.878.6980
When checking for benefits, where is the first place to check?
What is OLAM
180801 corresponds with which UM office?
What is Dallas
After submitting a TMS request form, how long until a follow up call is received by the provider?
What is 24-48 hours
What code would you provide your caller with if the service was a mental health assessment by a non-MD provider?
What is H0031
What would you do if a provider from Health Partners is looking to add a service location?
What is Transfer to Health Partners: 866 429 1474
There are two situations where an EAP auth can be written to a clinic ID. What is the name of one of those provider groups?
Orlando Behavioral Healthcare or Community Mental Health Center (CMHC)
Is an individual provider with a Master's reimbursement level eligible for reimbursement for a service provided to a member with a Medicare Advantage policy?
What is only if "Cigna Medicare Adv" is listed in Network tab in PMRS, otherwise No
Where would the Provider Data Management representative be found?
What is State Phone Grid
Is CPT code H0024 covered?
What is No
After misdialing 911 and informing Eden Prairie dispatch that the call was an accidental misdial, who do you inform next and through what system?
What is National Operations Administration and Skype
A provider has MAP coverage listed in CAMS allowing them 3 EAP visits, but their employer EAP benefits allow them up to 6 visits, how many visits are they really eligible for?
What is 6 (Refer to Hierarchy)
What would you tell a caller who asks how to bill for telehealth?
What is: "Claims should be billed using modifier 95 and/or place of service 02. The GT modifier will still be recognized for telehealth services as well."
A caller from an OON Facility has not heard a response in 30 days after submitting an application to be INN. What should you do?
What is send a provider services facility request email
For interchangeable codes 99324 and 99334, what kind of service is being provided?
What is Domicile/Rest Home visit with new patient.
Where would you direct a caller who's claim system says "Payer" in OneView?
What is, use the Client # (without the 0) to find the phone number on the Ptrack report doc
A provider calls for a member who is changing providers for EAP regarding their depression. They have used 2/6 sessions with the previous provider. What do you do next?
What is Create a new EAP authorization for the full amount of visits. Comment the original authorization to pay only the number of visits already used.
An OON provider asks if we accept assignment of benefits. What would you say?
What is “Yes. Depending on how the claim is filled out payment can go to either the provider or customer.”
What are the 2 things you need to verify for all network exception calls?
What is:
1) whether the customer’s plan affords coverage of OON benefits and
2) whether there are other contracted providers in the same or similar specialty area located within 25 miles of the customer’s geographic region
What service is provided for H0014?
What is Drug/Alcohol Rehabilitation
Does it matter if Alliance groups are using the CBH network or not?
What is Yes
A provider wants to add more EAP sessions for a member who has 10 sessions. Do you make more for them?
What is no (unless its a new calendar year)