Sutter EAP provides assessment, intervention, referral, short-term problem resolution, education, training, and consultation services to members and their eligible dependents covered by our benefit. These members each receive up to a pre-approved number of sessions each calendar or fiscal year with a licensed therapist.
Sutter EAP uses an Intake Counselor model for the delivery of EAP services. This model is uniquely designed to help members identify individual needs by working with an experienced Intake Counselor. The Intake Counselors are knowledgeable about resources available in the community, as well as being positioned to match the member with the individual therapist who will most closely meet his/her needs.
A provider who accepts a referral is sent documentation indicating the number of authorized sessions, including a section for summary information about the interaction with the client (action plan). This form is a simple one-page document with no required DSM diagnostic reporting necessary. After services have been completed, the contracted provider returns the document to Sutter EAP for reimbursement. Sutter EAP reimburses for late cancellations (less than 24 hours prior to appointment) and no-shows.
Are you interested in joining our Provider panel and becoming a part of the Sutter difference?
You will be required to submit:
- Proof of Malpractice Insurance
- Proof of State Licensure (2 year minimum licensing requirement)
- Cover letter detailing your preferred areas of treatment and services
- Professional Resume or C.V.
- Three (3) professional letters of reference
- A valid email address
Sutter EAP Provider Panel is full and not accepting new providers in the following areas:
- Davis, CA
- Fair Oaks, CA
- Auburn, CA
- Sacramento, CA zips 95816, 95818, 95825
- Santa Cruz County zips 95060, 95062, 95073, 95010
The following are answers to the most common questions Sutter EAP receives from providers. If your question is not answered below, please contact Sutter EAP. We are here to help!
- How should I bill when I am working with more than one family member, such as couples or family therapy?
- How should I bill when I am working with more than one family member and I see one or more participants individually?
- How do I identify patients on the check remittance advice?
- What are the guidelines for telephone sessions? Are they reimbursable?
- When can I bill for double sessions (two hours back-to-back)?
- How should I handle multiple late cancellations or no-shows by the same client?
If the employee/subscriber has unlimited sessions, use employee's invoice for the sessions in which he or she participates for billing. This includes marital counseling, family sessions or collateral sessions for a child who is the focus of treatment.
If the employee/subscriber and spouse each have a limited number of sessions, you may take turns billing for each participant if both parties participate in all the sessions.
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Be sure you have an authorization for the person you wish to see individually. You can not bill for a client's individual sessions on another person's invoice, regardless of the focus of the session.
If you have not received an authorization for the family member, advise the parent or individual (if over age 18) to call Sutter EAP for a phone intake and authorization. Sutter EAP is unable to issue an initial authorization based solely on a provider's request.
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The Explanation of Benefits (EOBs) we mail to you contains both the member name and a claim number. Retain the EOBs until your check (or direct deposit email notification) arrives, and use the EOB to match to the claim number(s) that appear on your remittance advice with the patient name.
Sutter EAP values the privacy and confidentiality of our members, and we go to great effort to protect it. The Sutter Health Finance Department is the entity from which all payments are made; regardless of which department generated the authorization for the payment. The name of the member does not appear on the check remittance advice because exposing a member's use of the EAP benefit to the Finance Department would be a violation of the member's privacy. By providing only the claim number to the Finance Department, we ensure we protect the identity of all who use the benefit, and that the trust given to us by our members is maintained.
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The standard of practice is face-to-face contact and is always preferable to the telephone for sessions.
Telephone sessions require prior approval by Sutter EAP, and may be indicated if a client's illness or injury makes it impossible to attend a session in person.
An extended absence of the provider may qualify if a client prefers to remain with that provider instead of being referred to someone else during the providers abscence.
Initial telephone screening of new clients, phone calls to schedule appointments, or "check-ins" between appointments are considered as sessions and are not reimbursable.
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The standard therapy session is the 50-minute hour. Double sessions are usually used only for emergent situations, or occasionally in couples therapy or family sessions. Sutter EAP does not consider it clinically necessary to routinely conduct double sessions for individual clients.
If you see a client for less than the 50-minute hour, bill for the actual time spent. However, it will count as a full session against the member's benefit. Likewise, if you see a client for an hour and a half, you should bill for the 90 minutes, and it will count as two sessions against the member's benefit.
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Although providers can not bill Sutter EAP members personally for missed appointments, it is important to take steps to minimize missed appointments by addressing the issue in therapy. Here are some things to consider if a client no-shows or has late cancellations more than two or three times in a six-month period:
- Is the appointment time inconvenient for the client?
- Does the client feel too overwhelmed to continue treatment at this time?
- Is the client not committed to the therapeutic process at this time?
- Is the focus or method of treatment not aligned with the client's goals?
- Would I handle the situation differently if no-shows were not reimbursed?
- Do you have a written no-show policy that is reviewed and signed by clients at the initial session?
- Some providers call clients a day or two ahead to remind them of their appointment time.