Sutter EAP Provider Network

If the employee/subscriber has unlimited sessions, use the employee's invoice to bill the sessions they participate in. This includes marital counseling, family sessions or collateral sessions for a child who’s the focus of treatment.

If the employee/subscriber and spouse each have a limited number of sessions, you may take turns billing for each participant if both parties participate in all the sessions.

Be sure you have authorization for the person you wish to see individually. You can’t bill for a client's individual sessions on another person's invoice, regardless of the focus of the session.

If you haven’t received authorization for the family member, advise the parent or individual (if over age 18) to call Sutter EAP for a phone intake and authorization. Sutter EAP is unable to issue an initial authorization based solely on a provider's request.

The Explanation of Benefits (EOBs) we mail to you contains both the member’s name and a claim number. Keep the EOBs until your check (or direct deposit email notification) arrives and use the EOB to match the claim number(s) that appear on your remittance advice with the patient’s name.

Sutter EAP values the privacy and confidentiality of our members. The Sutter Health Finance Department is the entity from which all payments are made, regardless of which department generated the authorization for the payment. The name of the member doesn’t appear on the check remittance advice because exposing a member's use of the EAP benefit to the Finance Department would be a violation of the member's privacy. By providing only the claim number to the Finance Department, we ensure we protect the identity of all who use the benefit.

The standard practice is face-to-face contact and is always preferable to the telephone for sessions.

Telephone sessions require prior approval by Sutter EAP. Phone sessions may be allowed if a client's illness or injury makes it impossible to attend a session in person or if a client prefers to remain with a provider who has an extended absence.

Initial telephone screenings of new clients, phone calls to schedule appointments and check-ins between appointments aren’t considered sessions and aren’t reimbursable.

The standard therapy session is the 50-minute hour. Double sessions are usually used only for emergent situations, or occasionally in couples therapy or family sessions. Sutter EAP doesn’t consider it clinically necessary to routinely conduct double sessions for individual clients.

If you see a client for less than the 50-minute hour, bill for the actual time spent. However, it will count as a full session against the member's benefit. Likewise, if you see a client for an hour and a half, you should bill for the 90 minutes, and it will count as two sessions against the member's benefit.

Although providers can’t bill Sutter EAP members personally for missed appointments, it’s important to take steps to minimize missed appointments by addressing the issue in therapy. Here are some things to consider if a client no-shows or has late cancellations more than two or three times in a six-month period:

• Is the appointment time inconvenient for the client?
• Does the client feel too overwhelmed to continue treatment at this time?
• Is the client not committed to the therapeutic process at this time?
• Is the focus or method of treatment not aligned with the client's goals?
• Would you handle the situation differently if no-shows weren’t reimbursed?
• Do you have a written no-show policy that’s reviewed and signed by clients at the initial session?
• Some providers call clients a day or two ahead to remind them of their appointment time.

Claims may be submitted via mail or Fax:

U.S. Mail:
Sutter EAP: Claims Department
P.O. Box 163149
Sacramento, CA 95816-3149
Fax:
916-503-6917
Attn: Claims Department

Secure Email*:
EAP@sutterhealth.org

*Important: Please be advised that every effort should be made to remove or minimize the amount of sensitive patient data submitted with a claim. Unsecured transfer of patient information through email may constitute a HIPAA privacy violation.

It’s further advised that all emails containing business or patient data are required to be encrypted, or to use other approved security transit measures to avoid potential exposure of sensitive data and violations of the HIPAA Security Rule.

Interested providers may submit their request via any of the following methods:

Email: SHPR@sutterhealth.org

Phone: 866-568-0332

Fax: 916-736-5094

US Mail:
Sutter EAP
Provider Relations Department
P.O. Box 163149
Sacramento CA, 95816-3149