You will receive an authorization form for every client that has been approved to see you. As an affiliate, it is important that you not schedule any client without getting authorization from MINES & Associates prior to seeing the client.
Below is a summary of the key elements in the authorization:
A set number of EAP sessions will be authorized. We expect you to do a thorough assessment of the client's needs and determine if those can be achieved within the limits of the specific EAP contract (available sessions vary depending upon the company or trust to which they are a member). The authorization received in the provider portal will identify the "Maximum EAP Sessions Available For This Contract (including any already authorized sessions)": We will work with you if a referral for ongoing care is needed.
For "Per Incident EAP Contracts", you are able to request additional authorizations. In order for additional sessions to be authorized, you must submit a “request for an additional authorization” (which replaces our treatment plan) outlining the new issue that has arisen and how it is separate and distinct from the previous issue. Please see part 4 of our tutorial series here.
Any sessions not authorized by MINES & Associates prior to seeing the client could result in nonpayment.
If you determine that a client needs to be referred out of the EAP to another provider, MINES & Associates must be contacted first. Please do not schedule another appointment for the purpose of passing on the referral information. Our Case Managers will work with you to secure the appropriate referral within the client's insurance benefit.
If the client needs to be referred for additional assistance, according to the EAPA Code of Ethics, self-referrals are potentially problematic due to potential conflict of interest. There may be clinical exceptions, and if so, these must be discussed with a MINES Case Manager.
After you have closed the client's file, if they contact you in the future to be seen again, you must contact MINES before scheduling with the client again. MINES will reopen the case for you. If all previously authorized sessions have not been used and have not expired, you will be able to use the remaining sessions. If you do not use all authorized sessions by the expiration date, the unused authorized sessions are no longer valid. MINES & Associates will then create a new authorization for the client to see you again.
All authorizations have expiration dates. If you do not use all authorized sessions by the expiration date, the unused authorized sessions are no longer valid. Also, if you have previously closed the case, it will need to be reopened. In both cases, you must contact MINES & Associates for a new authorization. Ideally, we hope that some sessions will remain so a client can re-access the EAP if another problem emerges during that contract year.
Make sure to submit billing for used sessions through the provider portal in a timely manner. If you have not received payment check to make sure that the status of any utilized session are "billed".
All files must be closed and paperwork received at our office no later than two weeks after the expiration date. Payment for services cannot occur until the completed paperwork is received.
Our need to closely monitor referrals is a function of the accountability demands of our client organizations. Increasingly, they are looking for greater specificity in terms of utilization, types of problems seen in the EAP, average lengths of stay, etc. Your timely compliance with these procedures helps us provide our client organizations with the data they need and service they seek; we see to it that the data are presented in such a way as to always guarantee client confidentiality. We appreciate your work and your cooperation with us. Please feel free to contact us with any questions or concerns you have.