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EAP

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rdmoore2003:
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)

PMRNC:
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.

gderilus:
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:
thanks for your help!!!

PMRNC:
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.

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