Get Magellan Healthcare Employee Assistance Service Information Form (easi Form) 2024-2025

Completing the Magellan Healthcare Employee Assistance Service Information Form, commonly referred to as the EASI Form, is a crucial step in ensuring timely reimbursement for services rendered. This guide provides a clear, step-by-step overview to help you fill out the form accurately online.

Follow the steps to complete the EASI Form online.

1. Click the ‘Get Form’ button to obtain the form and open it for editing.
2. Fill in the mandatory fields such as your clinician's name, Tax Identification Number (TIN) or Social Security Number (SSN), and the agency or organization details including address, city, state, and ZIP code.
3. Enter the case number or MAT number, along with the client's name and Magellan's client organization. Provide the dates for when the member first contacted you and when the first available appointment was offered.
4. Select the appropriate services provided by checking the corresponding boxes for sessions attended, whether inpatient or outpatient care, and if it was individual or family therapy. Document the session dates, start time, and duration.
5. Indicate if the bill is interim or final, and select the relevant race or ethnicity of the client.
6. Select the primary and any secondary assessed problems by marking the designated boxes.
7. Complete the statement of understanding regarding the member’s acknowledgment of services, and ensure to fill out the client’s level of functioning both before and after the sessions.
8. If applicable, complete the Risk of Harm assessment and provide any necessary explanations.
9. Review all the provided information for accuracy, ensuring that each section is completed fully.
10. Once finished, you can save changes, download the form, print it, or share it as needed.

Complete your EASI Form online to ensure prompt processing and reimbursement.