If you receive covered services from a provider who is not in the CBHA network, you may receive benefits for these services if (1) the provider is licensed to provide the service and (2) your plan provides out-of-network benefits. You may file a claim for out-of-network benefits using one of the following methods:

• Ask the out-of-network provider to file a claim on your behalf. Available benefits may be paid to the out-of-network provider, and you will owe any deductibles, co-pays, and coinsurance plus the difference between the CBHA rate for the service and the total charge. If the out-of-network provider requires payment up front from you, the claim may be filed to pay available benefits directly to you.
• Complete the first page of the CBHA Members Claim Form and ask the out-of-network provider to complete the second page of the form. Available benefits will be paid directly to you.
• Complete a CBHA Members Claim Form and attach a super-bill or other documentation provided by the out-of-network provider that contains complete billing information concerning the service.

Whichever claim filing method you choose, the following information must be included in the claim submission in order for processing to be completed:

• The name, address, and license of the provider of service
• The date(s) of service
• The procedure (CPT) code of the service rendered
• The diagnosis or diagnoses relevant to the service rendered
• The total amount of the charge for the service rendered

You may telephone the CBHA claims department at 1-800-475-7900 Monday-Friday from 8:30 am until 5:00 pm for assistance in filing your out-of-network claims. If the claim materials received contain incomplete or invalid information, the materials will be returned to you with a notice of the required information. Rather than having payment of benefits delayed, if you are unsure of the information that is needed, contact a CBHA claims representative for assistance.

Claims may be mailed to: 

Carolina Behavioral Health Alliance, LLC

PO Box 571137, Winston-Salem, NC 27157-1137

Or faxed to 888-908-7140, Attn: Claims Department.

• Complete the information page with your email address, home address, and the name of your employer.
• Select CONTINUE
• Select Recipient-claims
• Copy your file(s) onto the page. The file(s) will now appear within the loading dock.
• Select UPLOAD
• Your file will move to the header section, and a status icon will appear indicating that your document has been uploaded.
• Success! If all the required information is on the document, your claim should be processed within 10 business days.