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Billing and Reimbursement Published: October, 2001 Pre-Authorization EAP CPT Codes Accurate and Complete Claim Forms Timely Claims Submission Billing and Reimbursement PacifiCare Behavioral Health is committed to prompt and accurate claims payment. In order to achieve this result, PBH relies on providers to submit accurate claims. The PBH claims system is rule-based. This means payment of claims relies heavily on whether or not the claim form fulfills the rules for payment. The process is very simple, if you remember these things: All EAP services must be pre-authorized. EAP services are provided at no cost to the member and therefore there is no co-payment. Axis I diagnosis is not required for EAP clients. V codes or 799.90 for diagnosis deferred may be used for EAP claims when appropriate. Pre-Authorization All services, except emergency services for screening and stabilization, must be pre-authorized in order to receive payment. Services billed must match services authorized by: Service type (e.g. CPT code) Valid service dates Number of authorized visits Tax ID of provider performing services Back to Top EAP CPT Codes CPT Code Type of Service Description 90801 EAP-I Intake - Office 90804, 90810 EAP-V Office 20-30 minutes 90806, 90812 EAP-V Office 45-50 minutes 90847 EAP-V Family Psychotherapy 90853 EAP-V Group Psychotherapy Back to Top Accurate and Complete Claim Forms To ensure timely, accurate payment, all practitioner EAP bills must be submitted on HCFA 1500 forms. See Administrative Guide for HCFA 1500 form required billing information. Back to Top Timely Claims Submission All claims must be submitted within 90 days from the date of service. Claims for EAP services can be submitted through the website with a Web ID or mailed to:  PacifiCare Behavioral Health P.O. Box 31053 Laguna Hills, CA 92654-1053 Attn: EAP Claims If you have questions regarding a bill or payment of a claim, call the PacifiCare Behavioral Health Provider HelpLine at (800) 716-1166. Change of office address and/or phone number Addition or deletion of an office location Back to Top