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Do you enter BOTH EAP and regular insurance from the get-go? If not, there's no identifying information with EAP.

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5 comments

  • Kristine Doten

    I'm looking for the same information, Tracy.  I also have an EAP payer number that came up in the insurance payer options.  Then, I was asked to add a client, but could not see that my client was added....the EAP did not show up on their billing profile. In addition, the option to add a second insurance or "other" category is grayed out because I already have the primary insurance entered.  Do I need to take that out so the EAP can be billed?  Can I bill insurance for a DX session and then follow that with the designated number of EAP sessions that have been approved?  I can't figure out how to set this up so the proper entity gets billed. Thank you for some direction.

     

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  • Tracy E. Hill

    And worse, SP provides no call center/help center for any of these kinds of questions. We're truly struggling setting up for our group practice. The videos are good as overviews but not as deep dives into these kinds of questions. I'm super frustrated.

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  • Gillian

    Happy to help with this! When you've entered the client's EAP and health insurance payer into their profile, you'd set the payer you'll be creating a claim for as the Primary Insurer before creating the claim. 

    To submit a claim for your client, you'd change the status of the EAP insurer to the client's Primary so they'll populate onto the claims for the EAP sessions. To do this, navigate to the client's profile > Edit > Billing and Insurance. Change the client's health insurer to Other, change EAP to Primary, and click Save Client

    Please note that when you file a claim to the health insurer in between EAP sessions , you'd set that payer to the client's Primary. 

    Since EAP sessions don't normally have a member ID associated with them, we recommending submitting the claims outside of SimplePractice. The reason for this is because the claim will populate a scrub error with an empty Member ID field. 

    To submit a client's EAP claim, you'd create and print a claim form so it can be submitted outside of SimplePractice. The claim will remain in the prepared state as a part of the client's profile. It will live in the client's profile > Billing Documents box.

    Also, since SimplePractice doesn't handle the transference of insurance funds,  you'd manually add the payment from the EAP payer to the client's sessions by using their EOB. To do this, navigate to the client's profile > Add Payment box > Add Insurance Payment.

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  • Katie Badders

    But how do I add the EAP payment.  I did bill seperately as you suggested, but now that I need to add the EAP payment.  It only gives me the option of a payment from the insurance.  I do NOT want it to show up as client payment.   Can't there be an option to add EAP seperatly - not client pay and not insurance pay?
    How should I add this in?

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  • Ruth

    Hi Katie, currently there's no way to distinguish EAP payments from insurance payments. If you'd like us to consider adding this functionality in a future enhancement, please add it to our Ideas and Suggestions Board here: http://simplepractice.uservoice.com/ ! 

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