Employee assistance program (EAP)
Employee assistance program (EAP) services are separate and distinct from a patient's behavioral health benefit plan. EAP is pre-purchased by employers for its employees, their dependents, and members of their households (“Participants”). As part of the program, Participants have access to a pre-determined number of counseling visits per issue, per individual, per plan year, at no cost to the Participant. The number of sessions varies depending on the program model purchased by the employer. The goal of the program is, in part, to help Participants address personal issues and bring balance to their lives.
What kinds of issues are discussed during an EAP visit?
EAP services may include assessment and referral or short-term counseling. Patients may come to you for assistance with a broad range of issues, including but not limited, to:
- Relationship and marital concerns
- Parenting challenges
- Substance use
- Workplace stressors
- Depression and anxiety
- Ways to better manage stress and life’s daily challenges
- Loss and grief
Does the EAP have any exclusions?
The EAP benefit is not meant for long-term treatment/therapy and excludes the following:
- Psychiatric evaluations
- Medication management
- Psychological testing
- Court-ordered treatment
- Workers' Compensation/disability management/Family Medical Leave Act
- Fitness for duty/return to work determinations
- Employment law (more information outlined in the “Why is employment law excluded from the EAP?” section below)
Providing EAP services
EAP visits are separate from a patient’s behavioral health benefit plan, and no copayment is required.
Patients should have the information listed below when scheduling or at their first EAP appointment. You can also request this information on their behalf or verify an existing EAP request by completing a Coverage Confirmation Grid or calling Provider Services at 800.926.2273.
- Employer verification: Each employer verification covers one issue, per Participant, per plan year. Your patients may provide verification in the form of an alphanumeric code or employer name (effective May 5, 2025, for Disney Worldwide Services only; no other employer groups can use an employer group name):
- Alphanumeric, beginning with the two-digit code for the year the authorization was issued and ending in “*O” (for outpatient); for example, 231234567*O.
- Alphanumeric, beginning with “OP” (for outpatient) followed by 10 digits; for example, OP1234567890.
- “Disney” in place of an alphanumeric authorization code.
- Number of visits: The number of visits varies by employer.
- Dates of service: There will be a start date and end date for the issue.
Claims and payment
- All EAP services must be billed using Current Procedural Terminology (CPT®) code 99404 to ensure appropriate payment. While not required for claim payment, it is recommended to list “Disney” or the alphanumeric EAP authorization code in Box 23 on the CMS-1500 claim form.
- Claims must be submitted promptly after each EAP visit to comply with timely filing requirements. Depending on your patient’s EAP verification, the mailing address for claims submission will be different. When using an electronic data interchange vendor, payer ID 62308 is for all verifications.
| EAP verification | Mailing address | Fax number | Payer ID |
|---|---|---|---|
| Alpha-numeric code | Evernorth Behavioral Health PO Box 188022 - Chattanooga, TN 37422 |
859.410.2422 | 62308 |
| "Disney" | Evernorth Behavioral Health PO Box 188019 - Chattanooga, TN 37422 |
859.410.2422 | 62308 |
Forms
As an EAP services provider, the resources below may be helpful for you and your patients:
Evernorth EAP Clinical Assessment Form: A template that can be used by providers to document a clinical assessment.
EAP Statement of Understanding for Evernorth customers: A patient form that describes key elements of the EAP and collects a patient signature.
EAP Assessment and Specialty Opt-Out Form: A form providers should complete if they want to discontinue offering EAP services.
Why is employment law excluded from the EAP?
Coverage for employment law is excluded due to the dual nature of the EAP client relationship-the individual employee (or family participant) and the employer who sponsors the program. Any legal information or advice given by a practitioner to an individual client concerning employment law can have potentially detrimental consequences for the employer client. To avoid this conflict of interest, employment law services are excluded from the program.
In the course of providing EAP services, practitioners shall refrain from discussing legal recourse as a potential action in resolving workplace concerns or disputes. Employees with concerns about workplace practices should be referred to their Human Resources department for further assistance.
Examples of excluded employment law questions or concerns are:
- Workplace safety, accidents, injuries, or illnesses
- Coworker liability (including workplace assaults or threats)
- Employee benefits issues/disputes or disputes concerning the agents of company-sponsored benefits or services
- Pension rights, employment termination, retirement questions, or disputes
- Employer-based civil rights violations (including workplace sexual harassment allegations)
- All other alleged employer liability issues