Author Topic: EAP  (Read 2661 times)

rdmoore2003

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EAP
« on: November 02, 2009, 03:20:59 PM »
my provider is looking into seeing clients with EAP-mental health.  Can anyone explain to me in a brief but descriptive manner? (if that makes any sense)
Regina

PMRNC

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Re: EAP
« Reply #1 on: November 02, 2009, 04:52:04 PM »
EAP is Employee Assistance Program. I do a lot of these and no two are alike. Each EAP is different in how many visits allowed, etc. The biggest thing with all EAP or CAP (Confidential Advisory Program) is COMPLETE.. 100% PRIVACY
If a patient presents with a card and the EAP number is listed if you verify benefits or obtain authorizations, those are NOT to be sent to the patients Major Med or mental health carrier. In other words the major medical should not know about the EAP, it's there as a special benefit for confidentiality to the employee/family. It's very easy to check status of claim and call the wrong carrier. if that happens it's a major privacy breach that has to be taken seriously.

EAP's usually pay at 100% of fee schedule with no patient out of pocket. How many visits, what is needed (OTR, notes, etc) is up to each individual EAP plan.
I've had ones that don't require anything and then I've got ones that require an OTR after the first visit. You have to call the plan directly. The major medical plan will not be able to assist you with EAP questions. Only the EAP or the plan administrator can.

Linda Walker
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gderilus

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Re: EAP
« Reply #2 on: November 06, 2009, 04:32:02 PM »
How do you send claims for EAP, My provider sees a lot of EAP patients but she only email the patient's information to the EAP people for payment. Can you also use the 1500 form to send claims or what.  They take a long time to send payments, sometimes it takes the provider about 3 months to get paid. This is very confusing to me

rdmoore2003

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Re: EAP
« Reply #3 on: November 07, 2009, 07:50:16 PM »
thanks for your help!!!
Regina

PMRNC

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Re: EAP
« Reply #4 on: November 09, 2009, 07:08:11 AM »
It depends on the EAP, some want their own forms used, some will take the CMS1500, the only way to know their requirements is to check with each one. I have some that allow me to fax the claims and some require their original form be mailed. I have some that that pay as we go (decent time frame) and others who only pay out claims monthly and even one that pays quarterly.
Linda Walker
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gderilus

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Re: EAP
« Reply #5 on: November 09, 2009, 05:22:27 PM »
how do you manage EAP patients and A/R. Do you also use Practice Management software as if you were doing regular medical billing. Also, do u get EOB's from the EAP companies when you receive payments.

PMRNC

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Re: EAP
« Reply #6 on: November 10, 2009, 06:13:16 AM »
Yes, you should still manage EAP cases within the same PM Software Database, but because of the really tough privacy issues with EAP I create a separate patient file with an identifier to mark it as EAP.
Linda Walker
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gderilus

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Re: EAP
« Reply #7 on: November 10, 2009, 05:03:46 PM »
Do you have to go through denial and appeal process with EAP or do they always make full payments.

PMRNC

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Re: EAP
« Reply #8 on: November 11, 2009, 12:56:53 PM »
Not usually, In fact I can't recall ever having to appeal. The only denials you might get are eligibility ones.. for example a patient might be covered at the time you verified benefits but maybe something happened in interim and they were not eligible, for those you just bill the patient. Sometimes you will see the EAP saying the patient was not EAP eligible and if that's the case you verify benefits with the major medical carrier or mental health benefits from back of the card and resubmit to them. But in terms of denials EAP USUALLY pays at 100%, occasionally some will have a small copay, but most pay at 100% of the contracted rate. They are only temp benefits. Once EAP is exhausted claims then go through major med or the MH carrier.They are separate benefits.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

rdmoore2003

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Re: EAP
« Reply #9 on: November 13, 2009, 08:13:43 AM »
Thanks   This is all new to me.  My MH providers are just now deciding to get in network with insurance carriers and they are concerned about the EAP's.   Thanks for the help
Regina

bobbie

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Re: EAP
« Reply #10 on: November 13, 2009, 06:54:33 PM »
EAP for UBH/PCBH can be billed online thru their website. It's quick and very easy. I get pd in 7 days on those because you don't have to wait untill all alotted sessions are
completed, you can bill ea. one as it happens.

Just a reminder too that with the new year fast approaching alot of patients' plans will change. Don't forget to check on the transition benefits if they roll over to a plan your provider isn't contracted with. In California several of the insurance carriers and managed care panels are closed to providers (below an M.D. level) so we always look
for those transition benefits, especially for the large group employers. Ok, that has nothing to do with EAPs, I know. Got carried away.