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Note: Questions with an asterisk (*) require a response.

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* 1. What is the provider's name and license?

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* 2. What is the provider's location?

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* 3. Are you a BlueChoiceR HealthPlan Medicaid network provider?

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* 4. Are you a CBA Medicare Advantage network provider?

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* 5. If you answered no to question 4, are you interested in learning more about becoming a CBA Medicare Advantage network provider?

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* 6. Utilization Management (UM)

  Always Usually Sometimes Never N/A
My Insurance Manager(SM) is a useful tool for requesting authorizations.
CBA outpatient authorization forms are easy to use.
When a denial is issued, the denial reason is clearly stated.
The CBA Provider Manual is a useful resource tool for UM processes.
UM staff members are helpful in addressing my questions or concerns.

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* 7. Network Services

  Always Usually Sometimes Never N/A
Network services staff members are helpful in answering my questions.
Conducted site visits have been helpful.

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* 8. Continuity and Coordination of Care

  Always Usually Sometimes Never N/A
I share information with my patients' other behavioral health providers for care coordination purposes with a signed release from the member.
I share information with my patients' family doctors for care coordination purposes with a signed release from the member.
I receive feedback from my patients' other behavioral health providers.
I receive feedback from my patients' family doctors.
I am satisfied with the level of communication between myself and other providers concerning the care of my patients.

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* 9. Appointment Availability

  Always Usually Sometimes Never N/A
I am able to schedule an established patient or refer to another provider emergency room within six hours for a non-life threatening emergency.
I am able to schedule an established patient or refer to another provider or emergency room within 48 hours for urgent care.
I am able to schedule an established patient for a routine outpatient visit within 10 working days.
I am able to schedule a follow-up visit for a new patient within 60 days of the initial visit.

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* 10. Please indicate your extended office hours. Choose all that apply.

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* 11. Are your normally available for quick access appointments?

My Insurance Manager is a product of BlueCross® BlueShield® of South Carolina and BlueChoice® HealthPlan of South Carolina.

Medicaid managed care is administered by WellPoint Partnership Plan, LLC, an independent company.

CBA is a separate company that manages behavioral health and substance abuse benefits on behalf of BlueCross and BlueChoice®.

BlueCross BlueShield of South Carolina and BlueChoice HealthPlan of South Carolina are independent licensees of the Blue Cross and Blue Shield Association.

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