Frequently Asked Questions
How should I bill when I am working with more than one family member, such as couples or family therapy?
If the employee/subscriber has unlimited sessions, use employee's invoice for the sessions in which he or she participates for billing. This includes marital counseling, family sessions or collateral sessions for a child who is 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.
How should I bill when I am working with more than one family member and I see one or more participants individually?
Be sure you have an authorization for the person you wish to see individually. You can not bill for a client's individual sessions on another person's invoice, regardless of the focus of the session.
If you have not received an 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.
How do I identify patients on the check remittance advice?
The Explanation of Benefits (EOBs) we mail to you contains both the member name and a claim number. Retain the EOBs until your check (or direct deposit email notification) arrives, and use the EOB to match to the claim number(s) that appear on your remittance advice with the patient name.
Sutter EAP values the privacy and confidentiality of our members, and we go to great effort to protect it. 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 does not 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, and that the trust given to us by our members is maintained.
What are the guidelines for telephone sessions? Are they reimbursable?
The standard of practice is face-to-face contact and is always preferable to the telephone for sessions.
Telephone sessions require prior approval by Sutter EAP, and may be indicated if a client's illness or injury makes it impossible to attend a session in person.
An extended absence of the provider may qualify if a client prefers to remain with that provider instead of being referred to someone else during the providers absence.
Initial telephone screening of new clients, phone calls to schedule appointments, or "check-ins" between appointments are not considered as sessions and are not reimbursable.
When can I bill for double sessions (two hours back-to-back)?
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 does not 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.
How should I handle multiple late cancellations or no-shows by the same client?
Although providers can not bill Sutter EAP members personally for missed appointments, it is 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 I handle the situation differently if no-shows were not reimbursed?
- Do you have a written no-show policy that is 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.
How do I submit claims for payment?
Claims may be submitted via mail or Fax:
Sutter EAP: Claims Department
P.O. Box 163149
Sacramento, CA 95816-3149
Attn: Claims Department
*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 is 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.
Submit Your Request
Interested providers may submit their request via any of the following methods:
Phone: (866) 568-0332
Fax: (916) 736-5094
Provider Relations Department
P.O. Box 163149
Sacramento CA, 95816-3149