Carolina Behavioral Health Alliance (CBHA)
Credentialing Steps
Step 1- Complete Uniform Application
If you have access to the provider’s CAQH, the application could be downloaded and sent to the credentialing department.
Step 2- Complete Provider Skill Sheet
Step 3- Complete Blank Attestation Form
Step 4- Complete Provider Location Information Form
Step 4- Send the following forms & information to: credentialing@cbhallc.com
Uniform Application (or downloaded CAQH Application)
Provider Skills Sheet
Signed Attesatation
Provider Location Information Form
Copy of current professional license
Copy of professional liablity Insurace
Step 5- Add the documents sent via email to the Monday Credentialing Board and document updates completed.
Add a follow up date on the Board for 30 days and continue to follow up using contact information below!
*************************************************************************************************************************************************************************************************************************Credentialing Documents
*************************************************************************************************************************************************************************************************************************Website: https://cbhallc.com/providers/
Phone No: 336-499-4000 or (800) 475-7900
Email: Credentialing@cbhallc.com
Network Provider Rep- cbhaadmin@cbhallc.com
Address: P. O. Box 571137 Winston-Salem, NC 27157-1137
