Provider FAQs

A. We are always accepting applications for our provider network in Western New York. Please contact us if you are outside of WNY to see if we have a book of busness in your area.

A. Referrals may be made in one of two ways. An EAP client may contact you directly to request EAP counseling. They will identify themselves as being referred to you by EviCore EAP. You will also receive a fax or an e-mail from our EAP staff giving you the information about the client obtained in the initial phone call. This information will also contain a EviCore EAP reference number and authorized number of appointments. In certain instances, an EAP clinician may also contact you to coordinate services for an EAP client.

A. You can find a provider manual and all of EAP paperwork in our Provider Toolbox.

A. If at any time during the EAP episode of care the client presents with symptoms consistent with a DSM 5 diagnosis, our protocol is to stop EAP services and refer that client to a mental health or substance abuse clinician for a complete assessment. The client must be given a choice of providers. However, if they are comfortable being seen within the same facility, or with the same provider, they may continue to do so.

A. Claims are submitted using an original Red/White CMS-1500 Claim Form. Directions for claims submission can be found in the Provider Toolbox.

A. Once an episode of care has been completed, and the CMS-1500 Claim form has been submitted, payment will be rendered within thirty (30) days of receipt. Claim forms must be submitted within ninety (90) days of the date of service. Consult the EAP Claims Processing Manual found in the Provider Tool box for further information.

A. Problems are resolved in an expedient manner by contacting the EAP Program at 1-888-276-6632. The eviCore EAP Program Manager is responsible for overseeing the complaint process and will respond to participating provider complaints and concerns within three (3) business days.