Getting an EAP Authorization…

It’s important to remember that because, in most cases, Employee Assistance Program (EAP) benefits are available to employees and members of their household without eligibility verification, all EAP members must obtain an authorization for EAP sessions prior to meeting with the EAP practitioners.  Members can get authorizations by calling their EAP access number or by going to the CIGNA Behavioral Health (CBH) website (www.cignabehavioral.com) and logging on using their Employer ID and PIN.  Members are responsible for bringing their authorization number with them to their first appointment.  If a member does not have an authorization number at the time of his/her first EAP appointment, you, as a practitioner, can call CBH and obtain the authorization for the member.  You will need the member’s demographic information and the name of his/her employer. The member could also log on to the CBH website from your location and obtain the authorization.

 

For all EAP claims be sure to use CPT code 99404.  EAP claims can be submitted by mail to P.O. Box 46790, Eden Prairie, MN 55344 - A pre-formatted claim form with EAP mailing address and CPT code are available on the CBH website, or the service can be filed electronically on our website. In order to help us track EAP utilization and treatment outcomes, EAP practitioners need to call CBH to close EAP cases when completed.  When you close a case, you will be asked to provide the following information:  diagnosis, risk assessment, medication status, any chemical dependency issues, confirmation that the Statement of Understanding was signed, and recommendations for any further treatment, if needed.  Remember, you can self-refer for continued treatment beyond EAP if clinically appropriate.

 

Did you know…

As a participating practitioner with CBH, you will receive claim payment from CBH.  A member may pay for covered, authorized services before a claim is submitted if they are unaware of their benefits.  However, when the claim is submitted to CBH, the payment will be issued to the practitioner if that practitioner is contracted with CBH.  Other than a member’s copayment, a CBH participating practitioner should never collect payment for services up front.  Even if the member requests payment directly, CBH will remit payment to the participating provider.

 

CBH’s contract with the practitioner includes language surrounding benefit payment to the participating provider.  If you, as a practitioner, receive a payment for services that the member already paid for, it is your responsibility to reimburse the member the money already paid for services minus any plan liability such as copay, coinsurance, or deductible.

 

Tip of the month:  Please go onto our website, www.cignabehavioral.com, to add your provider self-introduction.  We currently have over 7700 self-introductions on the website. 

 

We’ve updated the look of our e-brief and would appreciate your comments.  You can reply to ProviderEducationSpecialist@CIGNABehavioral.com.  

Thank you!