Transcription of Application for EAP electronic claim submission
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Application for EAP electronic claim submission
Behavioral Health Resources For LivingSM Employee Assistance Program (EAP) Provider Application to Submit EAP electronic Claims Instructions To apply for EAP electronic claim submission access, fill out the applicant and provider sections your information to the boxes on the right of each section. The email address provided in #6 must be the same one that was provided to Availity. Then in the authorization section, sign and date the Application . Return it to us via email at or fax it to 959-282-8478. Onceapproved, we ll email you within 3 business days. If you have questions, call us at 1-888-893-6584 Monday through Friday, 8:00 to 5:00 ET.
Electronic Claims Instructions To apply for EAP electronic claim submission access, fill out the applicant and provider sections below. Add your information to the boxes on the right of each section. The email address provided in #6 must be the same one that was provided to Availity.
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