Headway can enter EAP info for clients with Optum or Cigna plans nationwide.
If you are credentialed with Optum and/or Cigna, you must accept EAPs. If your client would like to use their EAP, and it is through either Cigna or Optum, you must accept it.
Provider type restrictions
For Optum, only master level clinicians (i.e. master’s level Psychologist, LCSW, LPC, LMHCs) can accept EAPs. Optum does not allow doctoral level Psychologists (i.e. PhD, PsyD), Nurse Practitioners, or Psychiatrists (i.e. MD, DO) to accept EAPs through Headway.
For Cigna, doctoral level Psychologists or master’s level clinicians can accept these EAPs. Cigna does not allow Nurse Practitioners or Psychiatrists to accept Cigna EAPs.
How it works
We can add a client’s EAP on the backend. You can share the EAP information with us via the contact form.
We will need you to obtain and send us the following information from your client in the form of a letter from their insurance company or a screenshot [full screen] taken from the insurance portal. Typing the EAP details in the body of an email will not be accepted. If you do not have this information, you can have the client reach out to us directly.
Samples of acceptable documents can be found below, and must include the following:
- Authorization number
- Effective date
- Expiration date
- Valid sessions
Other information to send when reaching out, includes:
- EAP sponsor (if not clear in the letter)
- EAP Member ID if different from the primary ID (if encrypted / not visible on the letter)
- Number of sessions used, if any [For Cigna, if used sessions are with a different provider, a new authorization must be obtained]
We do not obtain EAP information as part of a general benefits verification, therefore, the above information must be shared with Headway ahead of time to ensure accurate billing.
Billing for EAP sessions
When billing for EAPs, you will confirm the session as you normally would. However, there are some restrictions on which CPT codes are available for EAP sessions (see below).
Any session you submit while there are EAP sessions available on the account will be automatically submitted as an EAP using the HJ modifier required by Optum.
After all EAP sessions are used, the client’s regular insurance benefits will process automatically.
Please note that even while a client is under an EAP, we require a payment method on file to submit appointments, in the event of a late cancellation (not covered by insurance).
CPT codes available
The following codes are allowed by Optum for EAP sessions:
- 90832
- 90834
- 90846
- 90847
- 90853
Any other codes will be denied or could cause implications for the client. Extended therapy visits (90837) are not covered.
The following code is allowed by Cigna for EAP sessions:
- 99404
Any EAP visit coded with any code other than 99404 will be billed through the client’s regular insurance.
Rates
You can view rates for this plan, and the EAP session CPT code on your Rates page.
Payments for these sessions will be paid to you as part of your usual bi-weekly payments from Headway.
Opting out
If you are credentialed with Optum and/or Cigna, you cannot opt out, and must accept EAPs. If your client would like to use their EAP, and it is through either Cigna or Optum, you must accept it.