United Behavioral Health & PacifiCare Mandate Change in Billing for Employee Assistance Programs (EAPs)

June 24, 2010Mental health

Effective July 1st, all Employee Assistance Program (EAP) mental health claims must include a specific modifier to be paid. To meet that requirement, we need your help in identifying when a patient is covered by an EAP. Without the EAP information, we cannot bill the claim accurately, and United/PacifiCare will either process the claim as a standard insurance claim or deny it.

Below is a Q&A summary of how this change affects you and Emax. If you have any questions about United/PacifiCare’s new mandate, please give us a call.

What information does Emax need?

In addition to the usual insurance and patient demographic information, we need to know:

  1.  Whether Employee Assistance Program (EAP) covers this patient.
  2. If so, for how many visits.

How should I provide that information?

You can let us know either by including a note on your encounter form, or you can include the information on the patient registration form. For your convenience, you can download an updated Generic Patient Registration & Insurance Information Form from our website.

The form includes a section for EAP coverage, and you can use the form for all patient demographic information. You can complete the form on your computer before printing, or if you prefer, print out a blank form and complete it by hand.

How will I know if a patient has an EAP?

We recommend that you make it the patient’s responsibility to tell you that their employer will be paying for a specific number of visits. Otherwise, the visits will be billed as regular insurance claims and subject to deductibles and copayments.


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