Employee assistance program (EAP)

Find the information and resources you need to provide EAP services—from understanding how the program works to verifying services, submitting claims, and accessing forms.

two women sitting and speaking, one holding a clipboard

What is an EAP?

An EAP is a free and voluntary program offered by employers to their employees and sometimes their dependents and/or members of the household (referred to as “Participants”).

While EAPs may vary by employer, all programs are designed to provide early support through assessment, referral, and short-term problem resolution services.

These services are separate and distinct from a patient's behavioral health benefit plan and are not intended to replace ongoing or specialty behavioral health care.

Choose the EAP services you offer

Upon joining the Evernorth Behavioral Health® network and anytime thereafter, providers may elect to offer EAP assessment and referral services and/or attest to meeting the qualifications and requirements to offer EAP Specialty Services. Participation preferences can be updated at any time by calling 1 (800) 926-2273.

Learn more

EAP assessment and referral services

As an Evernorth provider offering EAP assessment and referral services, you may deliver confidential assessments, short-term counseling, referrals to additional resources, and follow-up support, as appropriate. Participants may contact you directly to schedule an appointment, or you may receive referrals from Evernorth or Cigna Healthcare^®.

With EAP assessment and referral services, Participants have a pre-determined number of counseling visits per issue (minimum of three visits), per individual, per plan year, at no cost to the Participant. Prior to rendering services, it is important to verify if the Participant is using their EAP.

EAP services may include assessment and referral or short-term counseling for assistance with a broad range of issues, including but not limited, to:

Relationship and marital concerns

Parenting challenges

Alcohol and substance use

Workplace stressors

Depression and anxiety

Ways to better manage stress and life’s daily challenges

Loss and grief

EAP is not meant for long-term therapy or high-acuity needs and excludes the services listed below. It is a provider’s responsibility to appropriately refer the Participant to their behavioral health benefit plan or community resources, when needed.

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 (see below for more information)

Providing EAP services

As a reminder, EAP visits are separate from a Participant’s behavioral health benefit plan, and no copayment is required. Participants 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 1 (800) 926-2273.

EAP Authorization Code: Each EAP authorization code covers one issue, per Participant, per plan year. You should not provide EAP services unless you have verification in the form of an alphanumeric EAP authorization code or employer name* in the following formats:

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.

For the Disney Worldwide Services employer group, Participants will use “Disney” in place of an alphanumeric EAP authorization code. No other employer group can or will use an employer group name.

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.

Claims must be submitted promptly after each EAP visit to comply with timely filing requirements. Depending on your patient’s EAP authorization code, the mailing address for claims submission will be different. When using an electronic data interchange vendor, payer ID 62308 is for all verifications.

EAP authorization code	Mailing address	Fax number	Payer ID
Alpha-numeric code	Evernorth Behavioral Health PO Box 188022 Chattanooga, TN 37422	1 (859) 410-2422	62308
“Disney”	Evernorth Behavioral Health PO Box 188019 Chattanooga, TN 37422	1 (859) 410-2422	62308

Specialty services

In addition to assessment and referrals, contracted providers with Evernorth may also be eligible to offer EAP specialty services such as wellness seminars, critical incident response, EAP management referrals, and/or supervisor training. EAP specialty services providers may work in a consultative role with employers and managers to address employee and organizational challenges and needs. EAP providers can also help employers prevent and cope with workplace violence, trauma, and other emergency response situations.

Providers who meet the qualifications and requirements outlined in the EAP Specialty Services Criteria and Credentials Guide [PDF] will be contacted by Evernorth to schedule an EAP specialty service, as needed. Reimbursement for EAP specialty services is not claims-based and will be discussed at time of scheduling.

Forms

As an EAP services provider, the resources below may be helpful for you and your patients.

EAP Clinical Assessment Form: A template that can be used by providers to document a clinical assessment.

EAP Statement of Understanding Form: 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

Employee assistance program (EAP)

What is an EAP?

EAP assessment and referral services

What kinds of issues are discussed during an EAP counseling session?

Does EAP have any exclusions?

Explore all behavioral provider resources