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. 

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 be an identical process to submitting a 'typical' insurance claim with these caveats:

  • Optum/United Behavioral Health requires the inclusion of the HJ modifier code on their EAP claims. 
  • Cigna requires you to 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. 

Step 1: Add the EAP to the insurance database, giving it an obvious title (' Optum EAP', for example,). This helps keep it separate and easily searchable in your insurance Library.

In this Article:

If You are Submitting Electronic EAP Claims

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, so you'll want to be sure 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. An Example is Cigna EAP, which requires you to bill the 99404 CPT code in order to designate that it's an EAP session. Again, check with the EAP directly to find out what (if any) alternate code they want used on Electronic or Paper Claims.

EAP Claim Submission Requiring the EAP's Own Paperwork or going to the EAP Website to Submit the Invoice. 

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'. Actually printing the claim is not required. When the system asks if the 'claim' printed correctly, say 'Yes'. This will change the claim status to 'submitted' so that you can track this EAP claim alongside all of your insurance companies.