Our EAP is different from other payors because we pay you your same contracted rate ̶ there’s no difference.
What is the payment for EAP Services?
Unlike the employee assistance programs of other payors, Optum pays the same contracted rates for EAP services as for routine outpatient therapy services. And since the benefit is paid for by the member’s employer, the member has no financial responsibility – no deductible, co-payment or coinsurance amount. Optum reimburses the provider directly at the contracted fee schedule rate for authorized counseling sessions. Additionally, EAP services, while paid for by the member’s employer, remain confidential.
Who can provide EAP Services?
No special certification for delivering EAP benefits is needed. All our credentialed, contracted clinicians within the Optum network may provide, and are highly encouraged to provide, EAP services. No special certification is needed to see EAP members.
What is EAP?
EAP is a health and wellness benefit paid for by a member’s employer. It’s designed to provide assessment and referral, as well as a brief counseling intervention for members. The typical EAP benefit offers a limited number of sessions with a mental health or substance use disorder clinician for counseling services, but is not designed to provide an ongoing course of psychotherapeutic treatment. EAP benefits may also cover other areas of supports, such as legal and financial resources, WorkLife resources, and online articles and resources. The Optum network of clinicians offers members assistance with small questions, big problems and everything in between.
Not all members served by Optum have an available EAP benefit but those who do can generally see any contracted Optum clinician for EAP services. (Note that there are limitations around the use of EAP benefits with a psychiatrist.) The benefit is provided by a member’s employer and may be separate from the member’s behavioral health insurance policy. Many members who have EAP benefits through Optum also have Optum insurance, allowing for a smooth transition into ongoing counseling once a member has exhausted their EAP sessions.
By attesting, members will be able to search for you more easily
While all contracted providers are encouraged to accept EAP members and special certification for delivering EAP service is not necessary, Clinicians who do have specialized training and/or certification in this particular area and who attest to this speciality, will be highlighted as such when members search for providers in our provider search database.
Employee Assistance Professionals and Certified Employee Assistance Professionals
Employee Assistance Professionals and Certified Employee Assistance Professionals (CEAP) can login to providerexpress.com and attest to an Employee Assistance Program specialty.
- EAP Professionals must have at least 2 years of experience in the delivery of EAP core technology (as defined by the Employee Assistance Professionals Association), and at least one annual training in any of the eight EAP content areas
- Certified Employee Assistance Professional must be certified by the Employee Assistance Certification Commission
Again, specialized training or certification is not required to provide EAP services. If you meet the requirements outlined above, we encourage you to add this designation your profile, as an area of specialized expertise. This can help you to stand-apart as an expert in EAP, bringing you even more referrals.
EAP authorizations, billing and claims
Authorizations are required for EAP services and may be initiated by either the member or the contracted provider prior to the first appointment. To request authorization, call the behavioral health number on the back of the member’s insurance card. EAP authorization letters are sent directly to the member via e-mail or United States Postal Service mail. When a member presents for EAP services, inquire about the EAP authorization code number, effective dates and expiration dates, and whether any of the authorized visits have already been used.
The easiest way to bill for EAP services is to submit claims on providerexpress.com. Providers may need a subscriber ID for Optum EAP members. If the member also has Optum for behavioral health coverage, their subscriber ID is often the same for EAP. If the member does not have Optum behavioral health coverage, providers may call into Optum EAP 24/7 to confirm the subscriber ID.
All EAP Claims must include an HJ modifier following the CPT code to be processed and paid correctly. When billing on providerexpress.com, providers will be prompted to select BH or EAP. When selecting EAP, the HJ modifier will automatically populate. If the services are provided virtually, (i.e., via telephonically or by video conference) the GT modifier must also be included on the claim.