Employee Assistance Program and Behavioral Health Referrals: Some Difference

CIGNA Behavioral Health (CBH) offers multiple Employee Assistance Program (EAP) models to its customers, including the assessment and referral model (1-3 sessions) as well as short term counseling models (1-4 or more sessions). EAP is an employer paid program that can be offered alone or in conjunction with a behavioral health plan. Under the EAP, participants can be seen for just about any life issue, not just diagnosable mental health issues. During the EAP sessions, your skills can be used for assessment, coaching, goal setting, problem solving, consultation, planning and referral to community resources. Guiding the participant to the work/life resources of the EAP (including legal, financial, senior care and, child care) is a valuable component of the practitioner’s role. Because EAP is a separate and distinct program from a participant’s behavioral benefit plan, there are some procedures that differ from those of behavioral health referrals. Listed below are the most important EAP differentiators of which practitioners need to be aware:

• No Copays: EAP services are prepaid by the employer, so there are no out–of-pocket costs for the participant.

• EAP services require pre-authorization: EAP services are available to employees and their household members whether they’re enrolled in a health plan or not. With few exceptions, we do not verify eligibility for EAP accounts. For this reason, all EAP participants must obtain prior authorization for EAP counseling sessions. Participants can get authorizations by calling their EAP access number or by going to the CBH website and logging in using their Employer ID and PIN. Participants are responsible for bringing their authorization number with them to their first appointment. If a client does not have an EAP authorization number, practitioners may call CBH and obtain the authorization for them. You will need the client’s demographic information and the name of their employer.

• Use CPT code 99404 for all EAP services. EAP claims can be submitted by mail to P.O. Box 46790, Eden Prairie, MN 55344, or can be filed electronically on our website at www.cignabehavioral.com

• Statement of Understanding form: EAP clients should review and sign this form at their first appointment, and it should be filed in their chart. Click on the link to view form: Statement Of Understanding.

• Closing EAP cases: In order to help us track utilization and treatment outcomes, practitioners should call CBH to close EAP cases when they are 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. You may self-refer for continued treatment beyond the EAP if clinically appropriate.

   

Self Introduction Contest

Want to win an iPod Shuffle or a Starbucks Gift card? We want our participants to know more about you so we recently introduced a contest in an effort to get your personal profile on-line. Click on the following link to read all about it: Self Introduction Contest.

 

There have been several press releases regarding our provider Self Introductions – check them out!
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If you have topics you'd like to see addressed please let us know. Contact us at ProviderEducationSpecialist@cignabehavioral.com and we'll dig into it. We want this brief to be as informative and insightful as possible and to address topics important to our practitioner community.

   

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