EAP's are specifically negotiated by an employer to the insurance company. This means EAP procedure's are specific to the employer. It is possible to have two different clients with the same insurance company that have two different EAP procedures because their companies have negotiated different steps in their claim filing process.

It is the responsibility of the employee (your client) to present the EAP information to you. In most cases, in order to be eligible for an EAP, the employee would have received some form of documenation from the HR department of their employer. This information can sometimes include an authorization #, approved CPT codes, # of units and duration of the authorization.

Since many clients have their health insurance through their employer, it is very common for the EAP insurance company and the primary health insurance company to be the same insurance. This is why it is extremely important for your clients to provide the EAP information before the intake. The authorization number is what triggers the EAP claim. Without it, the claim will likely go onto the members primary insurance policy.

EAP's very rarely will have any client responsibility and also pay at different rates. Fixing this issue is much more complicated than filing the claims the correct way the first time. It is very important that clients identify if they are using an EAP before that first service. We recommend asking every client who provides their insurance information if it is an EAP to avoid these issues.

Almost every EAP will have an authorization number, approved CPT codes, an approved number of units and an approved duration.

Most - but not all - employers will provide this information to the employee (your client) at the time the EAP in authorized as a form. It is very important that you upload this form into your EHR.

If the client does not have an authorization form but is able to provide a number, we recommend that you confirm with the client that the client will be financially responsible (either through their own insurance or through direct pay) for the service if the authorization number is not accepted.

Sometimes there is not a 'traditional' authorization number. Instead, the employer will provide your client with a new policy number to use specifialy for EAP services.

It is very important that claims are filed to the right policy number so that the approriate benefits will apply.

These numbers will often follow the same policy # form as regular policy numbers from the same payer so they need to be noted in your EHR very carefully.

As your biller, we are not able to change the applied policy after your note is signed. It is your responsibility to ensure that the session is being applied to the correct policy before signing your note.

These billing issues can be rectified through voided claims and re-files, however it can be a tedious process and much better for everyone involved if it is done properly the first time.

Some EAP's require a separate filing process altogether through a specific payer portal.

In this case, we are able to handle this billing for you if we are provided the necessary portal access.

We will also need to see the authorization form as it will provide the necessary external billing instructions specific to the EAP.

Cigna EAP's are most known for this. If you have a Cigna EAP you will likely be billing a 99404 for your EAP sessions instead of a 90834 or 90837. Please review your authorization instructions to confirm.

Some EAP's will also only pay for 90834's or 90832's and not 90837's. If only a 90834 or 90832 is authorized the 90837 will sometimes be rejected outright or only paid at the authorized CPT code rate. It is very imporant to check your authorization form before you render services to ensure you are offering what has been approved.