New EAP Billing Option for Behavioral Health Providers

     For payers that require EAP billing to be submitted on a proprietary form that includes clinical documentation, we now are going to offer EAP claim submissions.

     Please note that this notice does NOT apply to payers (such as United Healthcare and Cigna) which allow for electronic claim submissions via the ANSI 837P format (the usual electronic claim format).  This notice only applies to payers (such as Magellan) that require EAP billing to be submitted on a form that includes clinical documentation.

     In order for us to submit EAP billing to payers like this, there are some important things to consider:

• Many payers have an EAP form or packet they provide you when authorization is given.  You must scan this packet (or form) and upload into your EMR.  This will also provide us the authorization number, the dates allowed under the auth and the number of EAP visits allowed.

• We must have access to your EMR.  If we do not already access your EMR, you would have to provide us a login and password.

• We must have access to that form or packet in your EMR.

• We must also have access to the notes for the patient so we can determine how to answer the various questions.  For example, in TherapyNotes, we must be given the role of Clinical Administrator.  If you do not want us having access to all notes for all patients, then when you want us to submit EAP billing you can print the notes as a PDF and attach to a ticket in the Support Suite.

• Your notes must provide all required information needed on the form.  If any information is missing (for example, Magellan asks various questions about percentage improvements), we will submit a ticket in the Support Suite and ask you the questions.  You should log in every day to the Support Suite to see if there are any tickets you have to respond to.  However, if all info that we need is in the notes, then we will not have to create a ticket.

• We will need login information for some websites (such as Magellan and Beacon Health Options).  We will notify you when we need such login information.

• Some EAP payers want billing submitted only at the end of treatment.  Others allow for interim submissions.  If billing is to be done only at the end of EAP treatment, notify us at the outset to hold billing until the end.  Then once we see the patient has used the last visit allowed we will submit the EAP billing.  For example, if John Smith has 5 visits allowed, we would submit after the 5th visit if you notify us to hold until the end.  Otherwise, we will submit EAP billing after each visit.

• Because EAP billing takes significantly longer when doing these specific EAP forms that include clinical documentation, the fee per EAP submission will be $14.95 per submission.  In addition, these EAP submissions will not count as free claims for providers who enrolled under an introductory special.

• Generally we will do EAP billing on the weekends, not during the week, because of the time required to complete the forms.

If your office wants us to submit EAP billing for you, let us know!

Thanks,

Steve