Get Easi Form - Magellan Provider's Home Page

This guide provides comprehensive instructions for users on how to accurately complete the Employee Assistance Service Information Form (EASI Form) online. Following these step-by-step instructions will ensure that providers can successfully submit the required information for payment processing.

Follow the steps to complete the EASI Form effectively.

1. Press the ‘Get Form’ button to access the EASI Form and open it for editing.
2. Fill in the required agency or organization details. Include the street address, city, state, zip code, and your assigned case number or MAT number.
3. Provide the client's information, including their name and Social Security Number (SSN), if applicable.
4. Document the session details. Enter the 'Time Seen' in minutes for the session, the start time of the appointment, and the present attendees, such as the employee and any dependents.
5. Indicate whether the bill is an interim bill or a final bill by filling the appropriate circle.
6. Select the race/ethnicity of the client from the provided options to ensure accurate demographic representation.
7. Mark the primary assessed problem by filling the corresponding circle or square from the list available on the form.
8. If applicable, complete the 'Referred to' section by selecting all relevant services provided.
9. Complete the statement of understanding regarding the member's signature or refusal to sign.
10. Rate the client's level of functioning before and after the sessions, as well as document the client satisfaction survey results.
11. Enter the percentage of improvement experienced by the employee in work capacity and activities of daily living.
12. Document any risks of harm and provide necessary details as required.
13. Finally, ensure that the clinician signs the form, including their date and telephone number.
14. Once all necessary fields have been filled, you can save the changes, download, print, or share the form as needed.

Complete your EASI Form online today to ensure timely processing and payment.