The Provider Operations department at CBH manages activities aimed at building and sustaining a proficient provider network to meet the behavioral health needs of CBH members. Provider Operations is comprised of three units: Network Development, Provider Relations, and Contracts.
- Network Development
The Network Development unit is responsible for ensuring that the provider network consists of quality resources to meet the behavioral health needs of CBH members. In collaboration with other CBH departments, its team members systematically identify and respond to gaps and needs in services. Network Development is the single point of contact for resource development and reconfiguration, which is completed through a procurement process. When providers and programs enter the network, Network Development team members conduct initial credentialing visits. They also provide training, technical assistance, and evidence-based practice implementation support to providers and programs within the CBH network.
- Provider Relations
The Provider Relations unit is comprised of representatives assigned to each in-network facility and practitioner, with representatives also assigned to manage the Out-of-Network (OON) processes. The Provider Relations representatives are the “go to” staff for providers; in collaboration with other CBH departments, they assist in resolving facility and practitioner concerns, including claims issues.
The Contracts unit, within Provider Operations, works in collaboration with CBH Provider Operations staff and other CBH departments to ensure that all contractedservices are in compliance with State standards for licensure, participation in the HealthChoices Medicaid managed care program, and other regulatory requirements.