How EAP sessions are authorized and billed: forms, codes and fax

Each EAP sets its own steps for authorizing and paying a session: Evernorth wants an authorization code or the employer name and requires CPT 99404, Optum takes claims by EDI or its portal on five HJ codes, and Lucet, Aetna Resources for Living and Anthem still take billing forms by fax.

How does an EAP session get authorized?

An EAP session gets authorized through the steps each EAP sets for itself: at Optum the member requests the authorization, at Lucet the provider leaves a voicemail, and at Evernorth the provider should have an alphanumeric authorization code or the employer name before giving any service.

The table sets each EAP's steps side by side, as its own provider page or manual states them.

Optum's Emotional Wellbeing Solutions page describes an employer-paid benefit whose members request authorization online through their Live and Work Well account or by phone at the number on the back of their ID card. The clinician can ask the member for the authorization information or check it with the Auth Look-up tool in the Provider Express secure portal. Evernorth's EAP provider page says each EAP authorization code covers one issue, per participant, per plan year, and an existing request can be verified by completing a Coverage Confirmation Grid.

At Anthem's EAP, the client calls and gives the EAP the date of the first scheduled appointment, the EAP sends referral and claims forms to the provider, and the provider calls the EAP to report the first session date. Anthem also asks providers to confirm, when the appointment is made, whether the session will be managed through EAP or Behavioral Health services.

The Carelon and Anthem EAP provider handbook, last updated May 2025, says a self-referral's notification prompts an authorization to be sent to the provider. Providers can look up a participant's authorization on the Carelon and Availity Essentials portals. When a participant contacts the provider before the provider has the referral, the handbook suggests calling Anthem or Carelon Wellbeing to confirm the sessions are authorized.

Lucet takes an authorization request as a brief voicemail message, which must come within 30 days of the initial session, and then faxes, mails or emails the authorization. The Aetna Resources for Living provider manual, document 7643802-01-01 ABH (3/26), says the member obtains the EAP authorization after choosing a provider and before the first appointment, and the authorization is sent directly to the provider. American Behavioral requires pre-authorization before all EAP sessions. ComPsych's Provider ResourceCenter is where designated users view referrals and request additional sessions.

How many sessions does an EAP cover?

The number of EAP sessions depends on the EAP and the employer: Evernorth participants have a pre-determined number of counseling visits per issue with a minimum of three, Aetna Resources for Living says the employer determines the number, and the Carelon and Anthem handbook says participants of one organization may be entitled to as many as eight sessions.

Evernorth adds that the number of visits varies by employer. Optum authorizes a limited number of sessions, in person or virtual, with a mental health or substance use disorder clinician. Once that limit is reached, the clinician can continue to see the member under the member's behavioral health benefit. Optum's page also says specialized training or certification is not required to provide EAP services.

Extra sessions follow each EAP's own route. Lucet may permit extensions beyond the session stop date of up to 30 days, and ComPsych takes requests for additional sessions through its Provider ResourceCenter. Aetna Resources for Living authorizations are not transferable to another provider or member.

Which EAP forms does the counselor sign, send and fax?

The forms an EAP counselor signs, sends and faxes belong to each EAP: Evernorth lists an EAP Clinical Assessment Form and an EAP Statement of Understanding Form, the Carelon and Anthem handbook requires a Participant Statement of Understanding signed at the first face-to-face session, and American Behavioral asks for a Case Closure Form at the end of the allotted sessions.

The table lists each form with its EAP, in the words that EAP uses.

Carelon's Forms and Guides page lists the EAP Provider Handbook and an EAP Provider FAQ. For a form that arrives by fax, see how to sign a fax and send it back.

How are EAP sessions billed, and by when?

EAP sessions are billed on each EAP's own code and form: Evernorth requires CPT 99404 for all EAP services, Optum accepts five procedure codes (90832HJ, 90834HJ, 90846HJ, 90847HJ and 90853HJ) submitted by EDI or its portal, and Carelon Wellbeing and American Behavioral take the CMS-1500.

The deadlines differ as much as the codes. Lucet's billing can go in during care or once all visits end, and it must be within 90 days of the last session. Aetna Resources for Living sets 90 days from the last session date for timely claim filing. Evernorth asks for claims promptly after each EAP visit to meet timely filing requirements.

Carelon Wellbeing moved from the Case Activity Form to the CMS-1500 on December 2, 2024: the CAF was required for EAP reimbursement for services rendered on or before that date, and the new process lets providers submit a CMS-1500 through the Availity Essentials Portal. For Anthem participants, the Statement of Services Rendered Form goes through the Anthem Provider Center for fastest reimbursement, or by mail or fax to EAP Claims. Providers can request copies of Provider Summary Vouchers through Carelon's automated PSV faxback service.

Evernorth's Claims and payment table lists payer ID 62308 beside its mailing address and a fax number column. Aetna Resources for Living encourages electronic claims. ComPsych's Provider ResourceCenter handles claim submission and claim status, and ComPsych uses CAQH for re-credentialing (ComPsych credentialing).

What can an EAP counselor share, and with whom?

Under the Carelon and Anthem EAP provider handbook, an EAP counselor must obtain approval from Anthem or Carelon Wellbeing before releasing any information, and the handbook points to the HIPAA-based Authorization to Disclose Health Information Form, posted on both the Anthem and Carelon websites. A separate guide covers the elements a HIPAA authorization form must contain.

For a formal referral, the handbook says providers should never communicate directly with employers, even if the employer makes contact, unless the participant authorizes it.

Anthem verifies fax numbers before PHI goes out. Under "ARRA Privacy Information," Anthem's EAP page says its associates verify fax numbers each time before faxing documents that contain Protected Health Information, and that PHI will be removed from the fax document. A provider who contacts Provider Services and verifies its fax number no longer has each fax verified, and PHI is not removed from documents for a period of one year. Anthem EAP also asks providers to notify Provider Services immediately when an address, telephone or fax number changes.

What mistakes hold up EAP payment?

The mistakes that hold up EAP payment are the ones each EAP names in its own rules: a Case Activity Form for a Carelon Wellbeing date of service on or after December 2, 2024 may be denied, Lucet reimburses only after the authorization is complete, and Aetna Resources for Living authorizations do not transfer to another provider or member.

• An Evernorth service given without an alphanumeric EAP authorization code or the employer name, or billed on a code other than CPT 99404.
• A Lucet authorization requested more than 30 days after the initial session, or a Lucet invoice without closing information, a signature and the date of case closing.
• A Lucet or Aetna Resources for Living claim past its 90-day limit from the last session.
• An American Behavioral session given without pre-authorization.
• An Optum Emotional Wellbeing Solutions claim on a code outside its five HJ codes.
• An Anthem session booked without confirming whether EAP or Behavioral Health services manages it, or a changed fax number that Anthem's Provider Services was never told about.

A delivery record shows when a faxed billing form reached the EAP, and a separate guide covers how to tell if a fax went through.

How do you handle EAP paperwork from a HIPAA fax account?

Fax Pigeon sends an EAP billing form, a Case Closure Form or a signed Statement of Understanding from the browser or from email, and a PDF, a Word file or a phone photo uploads as it is. Every delivered fax gets delivery proof to file with the claim, and a cover sheet is optional. Authorizations an EAP faxes back arrive at the practice's own number on every paid plan, in one shared inbox with roles and assignment where adding a biller costs nothing. Every plan includes a signed BAA at signup and unlimited people, from $4.99 a month billed annually for 200 pages.

* Official sources (Optum Provider Express, Evernorth, Anthem, Carelon Behavioral Health, Lucet, Aetna Resources for Living, American Behavioral, ComPsych) were read on October 20, 2026. Fax Pigeon prices and plan terms as of October 21, 2026.