Employee Assistannce Program (EAP) services are a separate and distinct benefit from an individual's behavioral health benefit plan. Some procedures that are offered through an individual's EAP may differ from behavioral health referrals.
EAP Services Require Prior Authorization
- When an individual needs EAP services, you should first verify that the individual has received authorization for the services.
- If the individual does not have an authorization, please call to secure the authorization on behalf of the individual.
- Please note that you should not perform the requested services until an authorization has been secured (as we cannot backdate EAP authorizations).
- EAP benefits and eligibility are not available on the HCP website. Call Behavioral Provider Service Center 800.926.2273 to inquire on EAP benefits and authorizations.
- EAP services differ from behavioral health benefits, in that there is no cost to the individual for EAP services.
- EAP services are prepaid through the individual's employer.
- Because of this, you should not collect a copayment or deductible when providing EAP services.
EAP CPT Code
- Please use CPT code 99404 when submitting claims for EAP services.
- If a claim is submitted with a behavioral health CPT code (e.g., 90834 or 90847), the claim will not process as EAP, and the customer will be charged a copayment..
- Please note that once we receive a claim with a behavioral health CPT code, we are not able to reprocess the claim as an EAP service.
Electronic Data Interchange (EDI) and Claims Address
- When submitting electronic claims for EAP services, please use Payor ID: 62308.
- If you are submitting paper claims for EAP services, please send claims to the following address: PO Box 188022, Chattanooga, TN 37422.
- The EAP authorization number can be noted in box 23 on the CMS 1500 form.
Closing the EAP Case
In order to assist us in understanding utilization and treatment outcomes so that we may continually improve service for our clients and customers, please call us to close out the EAP case once the services have been completed. During this brief phone call, you will be asked for the following information:
- Risk assessment
- Medication status
- Chemical dependency issues
- Future treatment recommendations (Please note that you can self-refer for ongoing behavioral health counseling. However, please verify the individual's behavioral health benefits before administering any services.)