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.

CLICK HERE TO RECEIVE CBH E-MAIL UPDATES 

National Provider Identifier Q&A

Executive Directors' Meeting

Reminder Notice to Current and Prospective Providers: Please be advised that unsolicited requests for new programs or program expansions will no longer be accepted for Community Behavioral Health (CBH) services.  The Philadelphia Department of Behavioral Health and Mental Retardation Services will utilize Requests for Proposals (RFP) and Requests for Qualifications (RFQ) to acquire new services or add providers to the CBH network.  Requests for the relocation of existing services may still be submitted for consideration.   

 Please note that the CBH website will be the only guaranteed method of notice for CBH-related RFP's and RFQ's.  RFP's and RFQ's are issued under strict requirements and any responses to an RFP that does not meet the specified requirements, including not submitting responses within the timelines stated in the RFP, will be cause for disqualification.  We encourage all current and prospective providers to monitor the CBH website regularly for new contracting opportunities. 

Reminder To All Providers:  Effective July 1, 2008, CBH has instituted a change in the billing clock which applies to all services provided on July 1, 2008 and later. In order to be considered for payment a provider must submit a Clean Claim no more than 90 days following the date of service for all Covered Services.   This 90-day submission requirement includes services requiring an authorization and services not requiring an authorization. 

 There is no change to the submission requirements for Providers pursuing Coordination of Benefits.  Providers must obtain a final determination from the primary payor dated no more than one hundred eighty (180) days following the date of service and submit a Clean Claim to CBH within ninety (90) days after receipt of a final determination from the primary payor. 

If Providers have any concerns regarding specific authorizations, which might affect the timely submission of claims, these concerns need to be addressed to Nancy Lucas, Chief Executive Officer.

NPI/Claims Processing Notice: A large number of electronic claims are still being submitted without the NPI number.  If you are in doubt as to whether or not you are sending a NPI within your claim file, it is recommended that you do the following:. 

1) Open your claim file within a text editor program.(Microsoft Notepad will suffice for most files)

2) Search for the pattern XX.  You should find it on a line that starts with NM1 and in the NM108 segment.  The NPI number will be the in the NM109 segment.

For Example:
NM1*85*2*Your Company Name*****24*123456789
This is the provider's TAX ID, not the provider's NPI.
NM1*85*2*John Doe INC*****XX*1234567890

This is an example of a provider's NPI.
For further reference, please refer to the National Implementation Guides for the 837I and 837P

Effective May 1, 2008, CBH will require that all physicians have National Practitioner Data Bank (NPDB) queries completed, at a minimum, every two years. The current policy, as stated in the CBH credentialing manual, indicates that these checks are to be completed every five years. This change is being effected in order to bring this check in line with the requirements for other background checks (child abuse and criminal history) that currently stand at every other year.  Credentialing teams will be requesting that evidence of these completed queries be provided to them for all physicians employed at a provider at the time of their initial or re-credentialing audit. Copies of these forms will be provided to the audit team to retain for the CBH provider file as well.
In the coming days we anticipate release of the first in the series of new scoring tools reflecting specific levels of care and/or provider specialties. You will notice that the new standard for NPDB queries is included in these tools, but will NOT be enforced until the May 1, 2008 date.

Performance Measure Development Phase I & II Draft Report

PHILADELPHIA DEPARTMENT OF BEHAVIORAL HEALTH
AND MENTAL RETARDATION SERVICES

PROGRAM DESCRIPTION GUIDELINES
 

PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE

LINKS FOR PROVIDERS

THE CITY OF PHILADELPHIA

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.
 

Mental Health Risk Factors Related to Childhood Obesity
 

 HIPAA LINKS

HIPAA RESOURCES
Updated 10/15/04

HIPAA FAQ
Updated 5/19/04

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