How do I bill for EAP?

You may want to double-check with the EAP because many have their own forms that must be completed and submitted manually. However, if the EAP will accept electronic submissions and you want to transmit the EAP claims electronically, sending an EAP claim is really no different than submitting a regular insurance claim. It must include all of the information that a 'regular' claim requires (i.e. demographic info, ID number, etc...).

A few things to keep in mind about electronic EAP claims:

ID numbers: With EAP's, they MAY recognize and accept the patient's 'regular' insurance ID number for EAP claims, BUT it's possible they'll require you to use another ID number (such as the patient's SSN) instead, so you'll want to be sure to check with the EAP directly to make sure you're giving them the information they need.

Modifiers: Many EAP's require you enter a modifier (such as HJ) to indicate the claim is an EAP claim, but again, you'll want to check with the EAP directly and confirm (1) Do they require a modifier? and, if so (2) What modifier they want you to use?

'Alternate' CPT codes: Some EAP's require you to use a different CPT code to indicate that it's an EAP claim. Again, you'll want to check with the EAP directly to find out what (if any) alternate code they want you to use.

With that being said, if the EAP requires their own paperwork, you wouldn't want to set up the claims to go electronically, but you can still add the EAP to your insurance database.

I'd recommend adding another insurance to your database specifically for the EAP. You could call it "[Insurance company name] EAP" to keep it separate from the 'regular' insurance, but set the 'Type of Submission' to Simple List rather than paper or electronic. When you do an [End of Day] the system will prompt you to print the simple list, but you don't have to actually print it if you don't want to (it opens in a new window). When the system asks if the 'claim' printed correctly, just say 'Yes'. This will tell the system that it has been sent to the EAP and help you keep track.

 

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