Diversify your business while providing care at a critical time

Optum accepts 5 procedure codes for Emotional Wellbeing Solutions sessions:

• 90832HJ: 30-37 minutes individual therapy
• 90834HJ: 38-52 minutes individual therapy
• 90846HJ: Family therapy without the patient in attendance
• 90847HJ: Family therapy with the patient in attendance
• 90853HJ: Group therapy other than family

When these codes are used, you’ll receive the same reimbursement rate as you do for routine outpatient therapy.

Reminders:

Claim submissions should include:

• An appropriate behavioral health ICD-10 diagnosis code (e.g., “Z” code)
• Required modifier – when selecting EWS, the HJ modifier will populate automatically
• If the services are provided virtually, such as by phone or video, you will need to include the GT modifier

If you work with employee assistance program (EAP) referrals as a network therapist, we encourage you to update your directory information to indicate you accept Emotional Wellbeing Solutions benefits. This information helps members easily identify therapists they can work with.

Login to our Secure Transacations with your One Healthcare ID and password.

• Individual clinicians – Go to the Practice Information page and click Edit under General Information
• Clinicians credentialed under a group – Go to the Edit Clinician page and click Edit under General Information
• Group practices - Go to the Practice Profile page and click Edit under General Information 

Employee Assistance Professionals

If you have specialized training as an Employee Assistance Professional or Certified Employee Assistance Professional (as outlined below), you can indicate this as an Area of Expertise specialty in your directory information. This can help you to stand-apart as an expert in EAP, bringing you even more referrals.

•  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 Professionals (CEAP) must be certified by the Employee Assistance Certification Commission.

To add this Area of Expertise to your profile, simply call the Provider Service Line at 877-614-0484 and attest to an Employee Assistance Program specialty. 

Reminder: Specialized training or certification is not required to provide EAP services. 

As part of their Emotional Wellbeing benefits, members may ask Optum for help identifying a provider to work with for their sessions. Those requests are handled by the First Call Provider Search team: 

1. The First Call Provider Search team chats with the member to understand what they’re looking for in a provider. (Training, experience level, gender, age, etc.)
2. Next, the team emails a small group of providers to confirm whether they have appointments available and that they meet the member’s criteria. (See example below)
3. Then, the First Call Provider Search team sends the member a list of provider options. The member would then schedule an appointment with their preferred provider.

To help ensure members are able to get support as soon as possible, please watch for and respond quickly to emails you receive from the First Call Provider Search team. The team has committed to respond to urgent member requests within 2 business days. Routine requests are handled within 3 business days.

First Call Provider Search Email Sample

Hello. I’m (name) with Optum Emotional Wellbeing Solutions, a modern and flexible employee assistance program (EAP).

To be respectful of your time, you do not need to respond if you cannot accommodate an appointment with this member based on the information requested below.

I’m assisting one of our Optum members in locating a therapist/counselor to work with for their Emotional Wellbeing Solutions sessions. We will share your information with the member for them to schedule an appointment.

This is an: (Adult/Teen/Child, Female/Male age XX)
Looking to address: (Condition)
Preference: (In office, evening, daytime, weekend therapy, open to virtual /telemedicine)

If you are accepting new clients with employee assistance program benefits and can see them for reasons stated above, please reply with the following information:

1. Therapist/Counselor’s Name:
2. Are you able to see a new member within 5 business days, with member’s preference above?
   • If no, when is your soonest availability?
3. Please indicate if you’re offering in office, virtual/telemedicine or both options?
4. Please confirm your address even if only offering virtual/telemedicine services:

NOTE: If you’re no longer accepting employee assistance program referrals, please indicate if this applies to your entire practice and whether it is permanent or temporary (e.g., due to a full patient schedule, other issues, etc.).

For more information on Optum Emotional Wellbeing Solutions, feel free to contact Optum at 1-866-248-4094 or use the following link: Emotional Wellbeing Solutions.

Thank you for your time!
(Insert signature)

Are Emotional Wellbeing services confidential?

Yes. These services remain confidential even though they are paid for by the member’s employer.

Can a member see any network clinician for Emotional Wellbeing services?

Members who have an available Emotional Wellbeing Solutions benefit can generally see any contracted Optum clinician for outpatient counseling intervention services. 

There are limitations around the use of these benefits with a psychiatrist or other clinician for medication management, as these services are not included in the Emotional Wellbeing Solutions program. In addition, not all members served by Optum have an available Emotional Wellbeing benefit.

What happens if the member needs support beyond the Emotional Wellbeing visits?

Many members who have Emotional Wellbeing Solutions benefits through Optum also are covered under an Optum or UnitedHealthcare health plan, which helps make the transition smooth. Once a member has exhausted their Emotional Wellbeing session limits, you may continue to see the member under their behavioral health benefit.

Is there a cost when a member transitions from Emotional Wellbeing visits to behavioral health benefits?

All Emotional Wellbeing visits are fully covered by the member’s employer. There is no cost to the member.

If you continue to work with the member using their behavioral health benefits, they may be responsible for a copay, deductible and/or coinsurance amount. The services a member receives and the amount they are responsible for are subject to the terms and conditions of their benefit plan, which may or may not be associated with Optum. To learn more details about the member’s benefit plan, call the behavioral health number listed on the back of the member’s ID card.