Signed in as:
Signed in as:
One applications to credential with the following:
Anthem Blue Cross of California
Blue Shield of California
PBH is linked with Headway in order to bring clinicians additional options with respect to claim submission and options and billing efficiency.
If you wish to be credentialed through PBH-Headway, please click on this (LINK) and complete the form.
If you have a question about PBH-Headway billing, please submit questions online by clicking on question for PBH support.
All other customer Headway service type inquiries can be submitted to headway.co/contact.
1. To start the Carelon credentialing process, complete the online form.
When you complete the application, select group and enter the following:
Group NP: 1154954303
The application will ask for Solo NPI and TIN. Make sure you enter the group information and not your own NPI or TIN.
Solo NP: 1154954303
The Carelon Website outlines the steps:
Step 1: Complete the application
Step 2: Submit a signed contract
Step 3: Credentialing process
Step 4: Final notice of acceptance
3. Complete the two following forms.
Complete this form and fax it to 866-612-7795. You can also email it to PBH Billing team.
Form 1. Behavioral Health Clinician Sheet Form (click here)
Form 2. Group Roster Form (click here)
Form 3. Site Information (click here)
4. Carelon Cultural and Professional Training Attestation
Carelon will send you the following forms and training materials:
a. Cultural Competence Attestation Form (click here)
b. Provider Orientation/ ABA Provider Orientation Form (click here)
c. Download the Group Training Attestation Roster form (click here)
Download the forms. After you review the training material, add your name to the forms and make sure to complete the questions at the bottom. Send the forms to email@example.com and cc firstname.lastname@example.org.
5. Contact Numbers:
Carelon Behavioral Health National Service Line: 800-397-1630
Carelon Behavioral Health: 800-888-3944
Kaiser credentialing can take up to 6 months.
1. Practitioner Addition Form
To start, fill out the Kaiser "Practitioner Addition Form".
Email the Practitioner Addition Form to KP-SCAL-Provider-Data@kp.org to get the process started.
2. Check Kaiser Application Status
To check on the status of your application, send an email to email@example.com
3. Lucet Account
The current timeframe is 5 to 7 days to establish Lucet Portal access after completing the training attestation. Both an email from Lucet and an email from SCAL BH Panel with be sent at the time of onboarding to the panel.
Kaiser will assign member appointments to your available slots that you create in your Lucet account. The Lucet account allows you upload the initial evaluation and requires that the Treatment Progress Indicator (TPI) be sent to the member as part of each visit. The TPI "appears to offer clinicians an objective approach to assess members and to monitor therapy over time".
4. Switching from another group (if applicable)
"The 6 month wait period is only applicable to a provider leaving a contracted Group and requesting their own Individual contract. In this scenario, a provider can be linked to more than one contracted groups. However if provider is leaving the group, patients cannot be taken from the group the original referral was made to. The group provider must follow clinical protocol for a smooth transition from the group, and to ensure there is no disruption in patient care in the process. If there are cases requiring special clinical review as part of the transition the provider will need to contact KP to coordinate treatment needs.
It is the responsibility of the Group administrator of each contracted entity to notify KP of any “roster” changes to add or remove an affiliate. These submissions are managed by Provider Data Services via the Community Provider Portal, (CPP). Upon receipt of a change request PDS will take the appropriate actions specific to notifying credentialing, and updating the provider’s Tapestry profile. The link to the CPP is below for reference (Click here).
5. Treat SCAL Kaiser Medi-cal Members
If you wish to offer services to Kaiser Medi-cal members, you will need to complete the following steps:
a. Enroll in state Medi-cal by enrolling in PAVE. To start the PAVE application process, submit your request through the PBH clinician portal. PBH will add you to the PBH PAVE account. You will then receive an email taking you to the PAVE website to complete the PAVE application.
Once you are approved, you will be a state medi-cal provider.
b. Update your provider profile in Lucet.
Here are the directions for this: How to Create and Edit your Profile and Site on Tridiuum ONE - Lucet Platform Knowledge Base - Confluence (atlassian.net)
c. When you are ready to treat Kaiser Medi-cal clients, send an email to:
6. Northern vs Southern Kaiser Members
NCAL = Northern Kaiser Region
SCAL = Southern Kaiser Region
PBH is contracted with SCAL Kaiser region. However, it is possible to provide services to NCAL Kaiser members.
The NCAL Kaiser rate is lower than the SCAL Kaiser rate.
NCAL Kaiser members can be assigned a SCAL Kaiser medical record number, as a courtesy. To schedule the NCAL member in Lucet, you will need to ask the NCAL member to obtain their SCAL medical record number. You will use the SCAL medical record number to hold an appointment slot in Lucet.
PBH is able to review NCAL member claims and payments.
7. Helpful Links
For information about KP SCAL Behavioral Health and Wellness offerings, please visit: https://thrive.kaiserpermanente.org/care-near-you/southern-california/mental-wellness/
For technical issues with Lucet: Home (site.com)
Visit http://providers.kp.org/ to learn about Online Affiliate and our provider self-service tools & get started today!
Online Affiliate/Claim Inquires: https://online.flippingbook.com/view/902264792/
Online Affiliate support or Claims Issues visit & open a case: https://kpnationalclaims.my.site.com/support/s/support-case
Electronic Claims, Payments, Remits: https://online.flippingbook.com/view/704125376/
To start the MHN credentialing process, please submit questions online by clicking on support.
You will receive an online application from PBH. After you complete the online form, the application will be submitted to MHN for review.
Please make sure your CAQH matches the information you list on your application.
MHN credentialed clinicians can accept MHN commercial members and MHN Medi-cal members (MHN Medi-cal requires PAVE enrollment).
Associates can only provide services to MHN Medi-cal members.
MHN Medi-cal rate is less than MHN commercial rate.
Medi-cal rate after 8% reduction.
Kaiser pays the same rate for both but not MHN.
Download and complete the following two forms:
1. Applied Behavior Analysis
County Service Form
2. Behavioral Health Practice Profile
Email the forms to firstname.lastname@example.org
PBH Team will submit the application.
Follow the steps outlined above to credential the associate through Carelon. Unlike other carriers such as Anthem and Cigna, Carlon does require the associate to complete the credentialing process.
Anthem and Cigna and Optum do not require the associates to be credentialed. These two only require the licensed supervisor to be on the claim form.
Requires prior authorization to have associate render services.
Add Associate to PBH Billing:
Start by completing the online join form for each associate.
1. Submit an online request for each associate through selecting the PBH online support.
a. Indicate which carriers will be linked to the associate.
b. Let us know if you wish to create any specific consent forms linked to the associate.
c. Do you want a simple Practice account opened?
d. Practice location?
e. Email address?
f. Do want the associate to be added to the group email?
PBH will send the Associate Volunteer Form.
While all clinicians are credentialed through PBH-Headway, employers who wish to have associates offer services will need to credential through PBH.
Complete the following online application (Click here).
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