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For your convenience, here are mental health and substance abuse benefits forms for  Companion Benefit Alternatives, Inc. (CBA). On behalf of BlueCross, CBA administers mental health and substance abuse benefits. CBA is a separate company.

Electroconvulsive Therapy Continuation Request

Electroconvulsive Therapy Initiation Request

Network Outpatient Treatment Report

Outpatient Treatment Continuation Form

Outpatient Treatment Initiation Form

Outpatient Substance Abuse Treatment Request Form: Continued Stay

Outpatient Substance Abuse Treatment Request Form

South Carolina Non-Network Outpatient Treatment Report

Please note: The State Health Plan provides Mental Health and Substance Abuse coverage through APS Healthcare, Inc. APS Healthcare, Inc. is an independent company that does not offer BlueCross BlueShield of South Carolina products or services. APS Healthcare, Inc. is solely responsible.