What is an EAP?
The Employee Assistance Program (EAP) is a health and wellness service paid for by an employer. It is designed to provide assessment and referral, as well as a brief counseling intervention for members and/or their families.
What EAPs does Headway accept?
Headway can enter EAP info for clients with Optum or Cigna plans nationwide.
Do I have to accept EAPs?
Yes – 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.
Which providers can accept EAPs?
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.
For both Cigna and Optum, you must be credentialed with Cigna and/or Optum in order to accept these EAPs.
What do I do if a client would like to use their EAPs?
We can add a client’s EAP on the backend. 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.
How do I bill for EAPs?
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).
What CPT codes can I bill for?
The following codes are allowed by Optum for EAP sessions:
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:
Any EAP visit coded with any code other than 99404 will be billed through the client’s regular insurance.