Addressing behavioral health (BH) needs is a critical and complex choice for an organization. CBA provides you with a behavioral health benefits partner with extensive experience, proven success, and a broad network of providers both locally and nationally. CBA understands of your members’ needs and operates on your behalf to address them.
We have invested heavily in developing behavioral health programs over the last 30 years to assist members who have behavioral health needs, desire counseling, and suffer from mental illness or substance use disorders navigate the journey to better health.
- Integrated Care Management
CBA is uniquely positioned to positively impact your total cost and quality of care because we manage your medical, BH, and dental benefits together in collaboration with your health plan.
We have demonstrated a significant impact for members managed by our BH programs when compared to non-managed members.
Integrated Benefits
We deliver high quality results because we manage members using an integrated population health management approach. We address the needs of every member across a healthcare continuum, offering solutions for members at every stage of health—from encouraging wellness to managing chronic, complex, and specialty conditions.
We segment the population into seven levels of care and offer targeted programs and services at the appropriate frequency and intensity as members move fluidly across the spectrum. Meeting members where they are and delivering individualized support is essential to lowering costs and achieving desired clinical outcomes.
Our focus on integration and coordination across the care continuum means that we:
- Use the same management tools and systems for BH benefits as those used for medical services, including prior authorization for admissions, procedures, and specific outpatient benefits.
- Share system access so care managers can coordinate to deliver member-centered and holistic support.
- Accept and leverage data from other vendors (e.g., pharmacy) to view and address multiple healthcare needs of a member during each interaction.
- Make every effort to refer members to community resources when benefits will potentially exhaust for a benefit year or are not covered, incorporating all federal parity governance into our decision-making processes.
Integrated Care
Our fully integrated platform provides a patient-centered view of all health and care management activities, including utilization management, case management (CM) (behavioral and medical), disease management (behavioral and medical), and wellness management.
This platform uses clinical decision support and case selection tools to continually identify member-specific clinical issues and regularly scan the population to identify the most appropriate candidates for case, disease, wellness, and behavioral disease and CM interventions. It triggers alerts when a patient is hospitalized or changes in risk status occur.
- Data-Driven Insights
By administering integrated benefits from a single team on a single system, as well as integrations with other vendors (e.g., pharmacy), the data we collect helps us identify trends and target areas that need to be addressed in the population.
This data-driven insight allows us to recommend precise actions that will help you reach your goals (e.g., reduce costs, improve quality).
To facilitate a coordinated approach and deliver an integrated and holistic member experience across BH and medical, all care managers use the same medical management platform. The shared platform allows any assigned staff to access all the care management notes associated with that member. Care managers are in communication with each other (via phone or email) to discuss updates or identified concerns.
- Insurance Claim Administration
CBA does not process claims directly but is completely integrated with BlueCross BlueShield of South Carolina's claims processing system.
Behavioral health claims passed through BCBS of SC take advantage of all integrated components.
These integrated components include:
- Eligibility database/system
- Benefit determination system (benefit maximums, deductible, per occurrence deductibles, coinsurance, covered/non-covered limitations, frequency limitations, etc.)
- Provider database (provider information and pricing)
- Utilization management/case management (CM) (pre-certification)
- 36 months of claims history (summary and aggregated)
- Financial systems and notification systems (generation of provider and member payments, explanation of benefit (EOB) statements, provider remittances, and letters)
BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross Blue Shield Association.