Employee Assistance Program (EAP)
Employee Assistance Program (EAP) services are a separate and distinct benefit from an individual's behavioral health benefit plan. EAP is pre-purchased by employers for their employees and their employees’ household members. As part of the program, employees and their household members have access to a pre-determined number of counseling visits per issue, per individual, per plan year, at no cost to the individual. The number of sessions varies depending on the program model purchased by the employer. The goal of the program is, in part, to help employees and their household members address personal issues and bring balance to their lives.
What kinds of issues are discussed during an EAP visit?
EAP services may include assessments or short-term counseling. Customers 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 excludes coverage for:
- Psychiatric evaluations
- Medication management
- Psychological testing
- Court-ordered treatment
- Workers' Compensation/disability management/Family Medical Leave Act (FMLA)
- Fitness for duty/return to work determinations
- Employment law
How do you administer EAP?
Below are some tips to help familiarize you with administration for all EAP offerings.
Providing EAP services
- EAP sessions are separate from the behavioral health benefits plan, and no copayment is required from the customer.
- The EAP is not meant for long-term treatment/therapy.
- EAP benefits and eligibility are not available on this website. If you have questions about administering EAP benefits, call the number on back of the customer’s ID card. If the customer does not have an ID card, they should contact the employer.
- If a customer would like to utilize their EAP benefit, they must obtain an EAP code and provide it to you prior to their first counseling session.
- If the individual does not have an EAP code, please call Provider Services at 800.926.2273 to secure the code on behalf of the individual.
- You should not provide EAP services unless you have an EAP code.
Claims and payment
- Use Current Procedural Terminology (CPT®) code 99404 to ensure appropriate payment, which can be noted in box 24D on the CMS/HCFA 1500 form. If you are providing virtual care services, include modifier 95 in Field 24-D.
- If a claim is submitted with a behavioral health CPT code (e.g., 90834 or 90847), the claim will not process as EAP, and the customer will be charged a copayment.
- Please note: Each EAP code covers one issue, per individual, per plan year. If a customer presents to you with a new issue within the same plan year, please contact us to obtain a new EAP code.
- Claims must be submitted promptly after each EAP visit to comply with timely filing requirements.
- Submit claims for EAP services electronically using your electronic data interchange (Payor ID 62308), or by mail to:
PO Box 188022
Chattanooga, TN 37422
- Providers must call 800.926.2273 to close a customer’s EAP case once care has been completed (see below for more information).
Closing the EAP case
To assist us in understanding utilization, treatment outcomes, and improving service for our clients and customers, please call us at 800.926.2273 to close out the EAP case once the services have been completed. During this brief phone call, you will be asked for the following information:
- Risk assessment
- Medication status
- Chemical dependency issues
- Future treatment recommendations (Please note: You can self-refer for ongoing behavioral health counseling. However, please verify the individual's behavioral health benefits before administering any 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