PPS and IO: EAP Billing

This article applies to the Private Practice Suite and Valant IO

System Set-Up

1. Create an EAP insurance company under Persons and Institutions|Insurance Companies

    a. Make sure to leave the “EDI Payor ID” field blank. This will ensure the system will not create electronic claims for EAP payors, in         case you forget to filter out EAP patient types when creating claims

2.  Create an “EAP” patient type under Reference Data|Patient Types


Patient Set-Up

1.  Collect both EAP information and the patient’s regular insurance information. One of these you will enter in the “Insurance 1” tab, and the other you can store in the “Notes/Image” tab

    a. If you need to switch back and forth, you will need to manually update the information in the insurance 1 tab

2. Use the “Authorizations” tab to track EAP visits that have been used.

    a. In the “Authorizations” tab, select “New Authorization

        i.     Enter the authorization code provided when the EAP visits were requested by the patient

       ii.     Select the appropriate EAP insurance

      iii.     Enter the number of allowed visits, and the number of visits that have already been used (if any)

3. On the demographics tab, select “EAP” as the patient type

 

Using Valant to track EAP claims

Since most EAPs require you to submit claims through a website, Valant cannot be used to generate claims. However, there is a way to “trick” the system so you can use the EMR to track claims and post insurance payments

1. Record the appointment as usual

2. Use the “Pending Insurance Claims” report, filtering by the appropriate EAP insurance, to pull up a list of claims that have not yet been marked as sent in the system

    a. Tools|Reports|Billing drop-down menu|Pending Insurance Claims

    b. Users can pull up a comprehensive list of all pending insurance claims by selecting “ALL INSURANCE COMPANIES,” or you can filter         by the EAP insurance you want to bill, or you can filter by individual patient

    c. Users will use this list as your To-Do list for EAP claims, submitting each visit to the appropriate insurance companies online             portals or mail-in form

3.  After submitting the claims, we will now tell the Valant system that you’ve done so

    a. Create insurance claims (Billing | Create Insurance Claims)

    b. In the Patient Type filter, select “EAP”, then select the “Only” radio button

        i. Users can also submit claims individually by filtering by individual patient instead of patient type

    c. Select claims format "CMS-1500 (08/05)"

    d. Click Create claims

    e. Ignore the PDF document that will pop up

        i. Alternatively, you can review this PDF to make sure  to mark the right claims as printed

    f. Click Mark Claims as Printed

4. Once you receive payment from the EAP company, you will be able to post insurance payments exactly as you would post any other type of insurance payment.

IMPORTANT NOTE: When submitting conventional insurance claims electronically or on paper, make sure to select the EAP patient type and then the “All Except” radio button, to make sure you aren’t accidentally creating EAP claims when you didn’t mean to. If you accidentally mark an EAP claim as printed before you submit it through the EAP portal, it will not show up on the Pending Insurance Claims report, so you may forget to submit it.

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