Frequently Asked Questions

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What is an EAP?
What services do EAPs provide?
Who qualifies for the network?
How are EAP services different from behavioral health benefits?
Do I need to notify anyone if I change my address or if I cannot accept new referrals for a while?
When I receive a counseling referral, what is the process?
How do you decide who gets referrals?
During the recredentialing process, is our status for referrals on hold?
What if a member contacts me and I am not in the network? What is the process?
Can a member see a provider if the provider is not in the EAP network?
As an EAP provider may I provide services to employees’ family members?
May I bill the EAP or the employee/client for “no shows?”
May I use my own billing forms for billing EAP visits?
Am I allowed to continue to provide treatment to a client beyond the EAP service?
Am I responsible for the authorization of insurance benefits when referring the client to myself following the completion of EAP services?
Can any provider with substance abuse training or state certifications assess employees who have tested positive for alcohol or drug use and work in jobs that fall under the federal DOT safety guidelines?
If I have any questions about billing issues, whom should I contact?
In a non-management referral, am I required to report substance abuse or other risk management issues to the EAP?
Can you use my CAQH records in lieu of completing an application?
Can you get me a CAQH#?
 
 
What is an EAP?
EAP stands for employee assistance program. Employers contract with companies that offer EAPs to help develop and maintain an effective work environment for their employees. Use of the EAP is designed to help promote greater productivity at work, a positive work/life balance, and preventive strategies through awareness and education to support early intervention. 
 
 
What services do EAPs provide?
EAPs provide initial behavioral and substance abuse assessment and referrals through face-to-face clinical counseling; crisis intervention; legal, financial, child care, elder care, and work/life referrals and information; critical incident management; training for employees and supervisors; management and human resource consultation; and assessment and case management of management and mandatory referrals.  
 
 
Who qualifies for the network?
Providers may apply to join the network who are licensed, in good standing with their licensing boards, and have one million/three million dollars of liability insurance. It is our preference that all providers also participate in our health plan behavioral health networks or our affiliate’s behavioral health networks.  
 
 
How are EAP services different from behavioral health benefits?
Services provided under an EAP are accessed differently and are not health insurance. EAP services include assessment and referral and/or short-term problem resolution. EAP services do not require utilization review, so there is less paperwork. The contracting employer, in some circumstances, is as much a client as the person receiving counseling, so it is important for providers to be aware of potential role complications whenever an issue involving an employer is the focus of counseling.  
 
 
Do I need to notify anyone if I change my address or if I cannot accept new referrals for a while?
Yes, you should contact the provider relations specialist in the corporate office at 888-650-5748, or fax to 888 438-7957 any changes in your address, phone numbers, etc. If you are going to be on vacation or otherwise unable to take any new referrals for a period of time, you should also contact the provider relations specialist with that information. 
 
 
When I receive a counseling referral, what is the process?
There are several call centers around the nation from which a referral may emanate. When a referral is given to you, either the client contacts you directly or a customer service representative contacts you on the client’s behalf. If the client contacts you directly, it is the responsibility of the client to call the EAP and request an authorization. With either process you will receive an authorization and claim submission form by fax or mailed before the appointment. See Confirmation and Claims for more information.  
 
How do you decide who gets referrals?
At the time of referral individuals are matched to a provider based on their preferences:  
Location
Specialties
and/or other individual needs.
 
 
During the recredentialing process, is our status for referrals on hold?
No, you are still able to receive referrals from us.  
 
 
What if a member contacts me and I am not in the network? What is the process?
If an individual has contacted you and you are not in our EAP network, you should refer the member back to their EAP customer service line. If you are interested in joining our network call (800) 962-1037, opt. 2, and speak with the provider relations specialist.  
 
 
Can a member see a provider if the provider is not in the EAP network?
If an individual has contacted you and you are not in our EAP network, you should refer the member back to their EAP customer service line. If you are interested in joining our network contact us at EAPProviderNetworks@Anthem.com
 
 
As an EAP provider may I provide services to employees’ family members?
The EAP provides services to employees and their household members. Each person who receives individual counseling needs an authorization from the EAP. The employee or household member will need to call the EAP to receive the authorization.  
 
 
May I bill the EAP or the employee/client for “no shows?”
No, EAP services are a company benefit paid by the employer; therefore, the employee should not be billed under any circumstances. The EAP pays the provider directly for authorized counseling sessions only; “no shows” are not covered by the EAP.  
 
 
May I use my own billing forms for billing EAP visits?
The Confirmation form includes a Statement of Services Rendered form that you may submit. Or if you choose, you may submit the CMS 1500 form. 
 
 
Am I allowed to continue to provide treatment to a client beyond the EAP service?
Yes, we encourage self-referrals when clinically appropriate for the individual to continue services beyond the EAP service. A freedom of choice information form should to be given to the client by the provider. You may access the Freedom of Choice in English or in Spanish
 
 
Am I responsible for the authorization of insurance benefits when referring the client to myself following the completion of EAP services?
Yes, you are responsible for adhering to all policies and procedures pertaining to the employee’s health plan provider network. An EAP authorization does not apply towards an employee’s health plan requirements for authorization of services, even when an EAP member is also a member of a health plan. In all cases, you are expected, as an EAP provider, to assist the employee in accessing their health benefits. 
 
 
Can any provider with substance abuse training or state certifications assess employees who have tested positive for alcohol or drug use and work in jobs that fall under the federal DOT safety guidelines?
No, only providers who hold a current substance abuse professional (SAP) certification can assess those employees who fall under federal DOT safety guidelines.  
 
 
If I have any questions about billing issues, whom should I contact?
You may contact the national office in Denver, CO at 888 252-2680 and speak with a provider relations specialist. 
 
 
What is a Management Referral? 
See Best Practices of Management Referrals for more information. 
 
 
In a non-management referral, am I required to report substance abuse or other risk management issues to the EAP?
No, the same confidentiality considerations you would have with any client apply. The provider can notify the EAP or employer at the employee/client’s request after obtaining a signed release of information from the client. EAP does not share employee information with employers consistent with relevant professional standards of conduct as well as state and federal statute unless authorized in writing by the employee. Reports to employers generated by the EAP contain only summary information and do not identify employees.  
 
 
Can you use my CAQH records in lieu of completing an application? 
Yes, we can utilize your CAQH records. We need your CAQH # and your record should be up to date and marked as Universal Authorization. This allows us to access your information. If you need assistance with the CAQH site, contact: 
CAQH Help Desk Phone: 888-599-1771 
CAQH Help Desk email: caqh.updhelp@acsgs.com  
 
 
Can you get me a CAQH#? 
Yes, we can issue a CAQH# for you. Contact us at EAPProviderNetworks@UniCare.com subject line NEW CAQH. One of our representatives will issue CAQH access for you to begin the process. 
 
 
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