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ALERT - EAP

EAP services are included in ALERT. Therefore, a Wellness Assessment is offered to the member early in treatment. Some EAP issues specific to ALERT are presented here.

Authorization of EAP Benefits
  • EAP benefits require specific authorization.
  • You may obtain an EAP authorization by calling the number on the back of the member's ID card, or 1-800-333-8724; you will receive an EAP authorization letter.
  • You will need to obtain a new EAP authorization when a new benefit year begins.
Transition from EAP to Mental Health/Substance Abuse (MH/SA) Benefits
  • You need to obtain prior authorization by sending in the Benefit Transition Notification (BTN) form or if you are a registered user, by using the Auth Request transaction on www.providerexpress.com.
  • Upon receipt of the BTN form or completion of the online Auth Request, Optum will generate an MH/SA open certification. The member will receive a letter indicating that routine outpatient psychotherapy services are certified. You will not receive a copy of this letter from Optum. Instead, Optum members will be instructed to bring this letter with them to their initial MH/SA session. If a member is continuing in treatment with you, as the clinician who provided EAP services, it is not necessary to wait for the member to bring in the authorization letter before continuing services.
  • The EAP clinician is usually the one to request the MH/SA open authorization upon completing EAP services. However, you need to ensure that it has been obtained. The member has been instructed to bring a copy of the authorization letter to the first session with you. If the member does not bring this letter, clinicians who are registered users of Provider Express may check to see whether or not the member has an MH/SA certification. You may also call the number on the back of the member’s insurance card. If an authorization is not in place, you may request certification at Provider Express or by phone at the time of your inquiry.
Non-Routine Psychotherapy and Medication Management Services Referrals
  • Non-routine psychotherapy services such as psychological testing and home health visits, as well as higher levels of care such as intensive outpatient treatment, still require prior review and authorization of benefits through Optum. Please call the number on the back of the member’s insurance card to inquire about authorization of non-routine services.
  • Medication management services under MH/SA benefits do not require prior certification.
EAP and the Wellness Assessment (WA)
  • All Optum members should be asked to complete the one-page WA.
  • If a member reports he or she has already completed a WA with the EAP clinician, it is not necessary to have them complete an initial session WA; however, a second WA should be offered at session 3, 4 or 5.