Seeing a client with an Employee Assistance Program (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.

EAPs accepted on Headway

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. 

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.

We’re also now able to offer Anthem’s EAP for Bank of America employees.

How clients can use their EAP

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.

Anthem Bank of America EAPs

How it works

Anthem EAP clients will be able to schedule based on your availability. In your calendar view, you will see EAP session on the booking to notify you if a client has scheduled under this plan.

Clients can be seen through their Anthem EAP benefits for 12 sessions per issue per year.

After these 12 sessions, you can continue care with the client through their primary insurance on Headway. Please note that you’ll need to be paneled with their primary insurance (if it’s not Anthem) to continue sessions once the EAP has been used.

Billing for Anthem Bank of America EAP sessions

All sessions held under a client’s Anthem EAP must be billed with 99404. Any EAP visit coded with any code other than 99404 will be billed through the client’s regular insurance.

These sessions are expected to last a therapeutic hour, which is considered to be 45-50 minutes of face-to-face or telehealth care.

For Anthem EAP, only clinical psychologists & master level therapists can accept this EAP.

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 didn’t opt-out of this program, you’ll automatically be eligible to see Bank of America clients that have Anthem EAP benefits. If you don’t wish to accept Anthem EAPs through Headway, let us know.