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region/plan-specific news : Employer Plans Nationwide

EAP providers: Duplicate billing to both EAP and behavioral health benefits is prohibited

Make sure when you request reimbursement using the client's Employee Assistance Program (EAP) benefits, that you do not also bill under the client's behavioral health (BH) benefits for the same date of service.

Recently, Magellan's Special Investigations Unit (SIU) has seen instances of providers billing under both the client's EAP and BH benefits for the same date of service, as well as using BH benefits prior to the end of the client's EAP session model.

Example of EAP and BH duplicate billing:  

A provider bills Magellan for EAP services rendered via the EASI Form, but then also bills Magellan for the same date of service under the member's BH benefit/ID number.

Consequences of duplicate billing:

  • Can impact costs and benefit accumulations for the member.
  • May result in Magellan investigating the organization’s billing practices and taking potential recovery actions.

More information:

  • Review Magellan’s policy and examples of fraud, waste, abuse and overpayment in section 4, page 79 of Magellan’s National Provider Handbook (PDF), including:
    • Misrepresenting the services performed.
    • An individual provider billing multiple codes on the same day where the procedure being billed is a component of another code billed on the same day.
  • Review Magellan's policy on referring the client using health plan behavioral health benefits after completion of all available EAP sessions or if the care is beyond the scope of EAP services in section 2, page 5 of the EAP handbook supplement.

If you suspect someone of unethical billing practices, contact the SIU via email (SIU@MagellanHealth.com) or via our hotline 1-800-755-0850 (you may remain anonymous).

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About Provider Focus

Welcome to Provider Focus, our award-winning e-newsletter for network providers! Here you’ll find articles and information to keep you up-to-date on news and topics relevant to serving Magellan members, including a section for regional- and plan-specific news. Check back as a new issue is released each quarter.

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