How do I bill for sessions covered by an Employee Assistance Program (EAP)

TherapyAppointment makes it easy to track payments due from Employee Assistance Programs.

In this Article:

• Submitting Electronic EAP Claims
• Patient ID Numbers
• Alternate CPT Codes
• EAP Claims / Paperwork

Before billing an Employee Assistance Program, double-check with them about how they wish to receive your 'claim' for services:

• Some EAP's (such as Optum and Cigna) allow for electronic claim submission
• Others (Magellan EAP) may require you to submit the claim via their website
• Still others (Aetna) may require you to mail in a paper form they provide.

In the vast majority of cases, you must be credentialed with the EAP in order be paid by the EAP.

If the EAP accepts electronic claim submissions, sending an EAP claim can be an identical process to submitting a 'typical' insurance claim with these caveats:

• Inclusion of the HJ modifier code on their EAP claims

• Use the CPT Code 99404 in order to indicate the sessions is billed under EAP
• Both Optum and Cigna require the inclusion of the Authorization number on the claim

Additionally to consider:

Patient ID Numbers

EAP's may recognize and accept the patient's 'regular' insurance ID number for EAP claims, but it's possible they'll require you to use another ID number (such as the patient's SSN) instead.

You'll want to check with the EAP company directly to make sure you're using the correct patient ID number. 

'Alternate' CPT Codes

Some EAP's require the use of a different CPT code to indicate that it's an EAP claim.

EAP Claim Submission Requiring the EAP's Own Paperwork (or EAP Website)

If the EAP requires their own paperwork or requires you to go to the EAP website to submit the invoice vs. accepting electronic claims or paper HCFA forms, set up the EAP as an insurance company in your TherapyAppointment account, and set the claim submission type to simple list.

Doing so will allow you to attach a 'claim' to the date of service and will allow you to track unpaid claims that you're waiting on for the EAP. 

The claim will then be listed under 'Claims Ready to Print' on your Billing and Insurance Screen, prompting you to print the 'Simple List'.

Relevant:

• How to Add an Insurance Company
• How to Add a Modifier to an Provider's setting that ALWAYS needs to be included for claims to the insurance (Such as the HJ modifier for Optum EAP Claims)