Get Eap Tracking And Case Closure Form For Eap Billingpayment

Filling out the EAP Tracking and Case Closure Form for EAP Billing/Payment is an essential process to ensure reimbursement for services provided. This guide will outline the necessary steps to complete the form accurately and efficiently.

Follow the steps to fill out the form correctly.

1. Click the 'Get Form' button to access the form and open it in your document editor.
2. Begin by entering the client’s name in the designated area at the top of the form. Ensure that the full name is spelled correctly.
3. In the section marked Pt ID# or SS#, enter the appropriate identification number as found on the client’s authorization letter.
4. For the employer and provider name fields, fill in the respective information relevant to the client’s employer and the name of the provider giving the services.
5. List any additional individuals who attended counseling with the client in the provided space. This is important for maintaining accurate records.
6. Indicate the case disposition by selecting 'Open and Active' or 'Closed' based on the current status of the case. Provide a reason for closure in the section that follows if applicable.
7. Fill in the dates of service in the specified fields. List each date for the services provided, ensuring to include all relevant visits.
8. In the DSM IV diagnoses section, complete the appropriate Axis entries accurately to reflect the client’s diagnoses.
9. If the case is closed, input the Opening GAF and Closing GAF scores to provide additional context on the client’s progress.
10. Select the option that explains the reason why EAP services have ended. Ensure to check the box that correctly reflects the situation.
11. Enter the date when the form is being completed and sign off in the clinician signature section, listing your credentials as well.
12. Finally, return the completed form via mail or fax to the designated address provided at the bottom of the form.

Complete your EAP TRACKING AND CASE CLOSURE FORM online today to streamline the reimbursement process.