Intensive Behavioral Health Services (IBHS)-Applied Behavior Analysis (ABA) Application

Community Behavioral Health (CBH) is soliciting applications for Intensive Behavioral Health Services (IBHS) - Applied Behavior Analysis (ABA) providers. Interested qualified applicants should complete the below application. CBH will review all submissions and will contact qualified applicants.

Name of Person Completing Form

Provider Name

Contact Email

Please enter the email of the point person responsible for credentialing. Follow-up regarding next steps will be emailed to this address.

Are you enrolled in Pennsylvania Medicaid?

Are you currently enrolled in PROMISe as an IBHS-ABA provider?

Were you previously an in-network CBH Provider?

What do you expect your CBH member capacity to be?

How many CBH members do you project serving per year?

Guidelines & Performance Standards

Do you agree to adhere to CBH’s Clinical Practice Guidelines and Performance Standards included in the CBH Provider Manual?

File Upload

Please attach a copy of your agency's IBHS-ABA license

Drop your files here

Note/Comments

Send me a copy of my responses

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