Coordinating and Accessing Care
Many members who are enrolled in the Community HealthChoices (CHC) program will also have their behavioral health needs managed by Community Care.
Behavioral health care is different from physical health care and long-term services and supports (LTSS). We are here to help members with:
- Mental health conditions
- Substance use disorders
- Developmental disabilities
- Answer their questions
- Help them find care providers
- Make sure they're receiving the right services
- Make sure their services are covered so they don't have to pay for them
What if a member needs outpatient services?
Members may contact and schedule appointments with any outpatient provider in the Provider Directory. Neither a prior authorization nor a referral from Community Care or another provider is required to see a network outpatient provider.
What if a member needs inpatient care, partial hospitalization, sub-specialty care, or other behavioral health care services?
Usually, the member's treating provider will arrange hospital care, partial hospitalization, sub-specialty care, or other behavioral health care service. If you think a member needs these services, either they can make arrangements, or you can help them make arrangements with any provider in the Provider Directory. Neither a prior authorization nor a referral from Community Care or another provider is required for these services.
What if a member has general questions about Community Care or is unsure about something?
Our member service line is a great place to start. Customer service representatives are available 24 hours a day, 7 days a week at the member lines below. Members may contact us if they need assistance or have questions on how we make decisions about their care.
- Allegheny County: 1-800-553-7499
- Blair County: 1-855-520-9715
If a customer service representative is not able to help, they will make sure that someone from the Care Management Department can help.
How do CHC plans, service coordinators, and providers coordinate care for members who are enrolled in the CHC program and have Community Care for their behavioral health coverage?
The best place to start is to call our Coordination of Care Line: 1-844-488-5336. Please select the Community HealthChoices option. A customer service representative will initially assist you.
What do care managers do?
Our team of licensed and specialty care management clinicians can actively work with you. Care management operates 24 hours a day, 7 days a week, with clinical supervisors on call at all hours. All care management staff have direct access to Community Care's professional advisor staff, 24 hours a day.
Some of the things care managers do include ensuring coordination and continuity of care; consulting with physicians as needed; coordinating care between behavioral and physical health providers; and reviewing and authorizing services.
Are there other ways to contact someone in the Care Management Department for purposes of coordinating or collaborating care?
Yes. Community Care already collaborates extensively with physical health plans. You can use the following email address to contact someone in Care Management.
- If the member is from Allegheny County: CCBH_ICPAllegheny@ccbh.com
- If the member is from Blair County: CCBH_ICPBlair@ccbh.com
Both email accounts are monitored by care management staff; someone will get back to you.
Do I need a Release of Information (ROI) in order to talk to someone at Community Care?
We developed a Consent to Release Health Information form to facilitate direct communication between PH/BH providers and MCOs. This form may be found on our website: www.ccbh.com/providers/phealthchoices/forms/.
You may have your own ROI form and are free to use it. Health plans are permitted to coordinate care without an ROI, with the exception of HIV and substance use information.
What do I do if someone I am working with is in crisis?
Use the behavioral health crisis services available in the appropriate county.
- Allegheny County – resolve Crisis Services: 1-888-796-8226
- Blair County Community Crisis Center: 1-814-889-2141
Our county partners play an important role in the well-being and welfare of our members. Contact information for:
- Dept. of Human Services (DHS): 412-350-4457
- DHS Director's Action Line (DAL): 1-800-862-6783
- Blair HealthChoices: 814-696-5680
- Dept. of Social Services: 814-693-3023