How do I bill for EAP?

Before beginning, double-check with the EAP (many have their own forms to be completed and submitted manually). If the EAP accepts electronic submissions, sending an EAP claim will resemble the process of submitting a 'typical' insurance claim. Make sure it includes all of the information that a regular claim would require (i.e. demographic info, ID number, etc).

Regarding Electronic EAP Claims

ID Numbers

With EAP's, they 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 directly to make sure you're giving them the information they need.

Modifiers

Many EAP's require entering a modifier (such as HJ) to indicate the claim is an EAP claim. Check with the EAP directly and confirm these questions:

  • Do they require a modifier?

If So...

  • What modifier do they want used?

'Alternate' CPT Codes

Some EAP's require the use of a different CPT code to indicate that it's an EAP claim. Again, check with the EAP directly to find out what (if any) alternate code they want used.

EAP Paperwork

If the EAP requires their own paperwork, setting up the claims to go electronically will not make sense. However, the EAP can still be added to your insurance database.

EAP End of Day

It is recommend to add another insurance to the insurance database, specifically for the EAP. Give it an obvious title (' insurance company name EAP', for example). This helps keep it separate and easily searchable. Make sure to set the Type of Submission to 'Simple List', rather than paper or electronic. During the 'End of Day' process the system will give a prompt to print the 'Simple List'. This printing option is not required. When the system asks if the 'claim' printed correctly, say 'Yes'. This tells the system it has been sent to the EAP, which will your practice help keep track.

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