May my intern see my Exclusive Care patient as long as I am supervising the intern?
Referrals are only valid to licensed professionals who have been credentialed by and contracted with Exclusive Care. Therefore, referrals to interns are outside the contracted agreement with Exclusive Care and claims submitted for services provided by intern will not be paid.
How do I go about referring a client for additional services such as family, conjoint, substance abuse treatment, medication evaluation or hospitalization?
Contact the EAS/Exclusive Care case manager designated on the authorization document you received. The case manager’s role is to consult with you to determine medical necessity and prepare an authorization for the referral you are requesting. If a client is in immediate danger to self or other promptly hospitalize and inform the EAS case manager. If the designated case manager is unavailable, someone else in the EAS office will be available to you.
How do I obtain additional visits?
Visits are requested by faxing the form titled “OUTPATIENT SERVICES REQUEST”
. Allow up to 15 business days for an authorization to be processed and faxed back to you.
A former client has returned after a lapse in time do I need to obtain authorization?
Another authorization is required if the previous authorization has expired by the month/year date or if all visits on the previous authorization were used. Allow up to 15 business days to process, prepare, and fax the new authorization to you.
My client is asking for conjoint and or family therapy with me how do I obtain authorization?
Your primary point of contact on any case is the EAS/Exclusive Care case manager designated on the authorization document you received. For a case consultation at no charge, the case manager is available to review the case with you to discuss the self-referral being made by the client.
What is expected of me when a new referral does not respond to my phone call(s) for an appointment?
Fax the termination portion of the treatment plan back to the case manager stating what occurred e.g. that your calls were not returned or that the client did not show after “x” number of cancellations.
Is psychological testing available?
The Exclusive Care plan does offer psychological testing for adults and teens starting at age thirteen. The report will be completed within 3 business days of your client being tested. To request psychological testing, download the “Psychological Testing Referral Form”
by clicking here. The referral form includes a check list of questions to which you may add a specific request to be addressed by the testing psychologist. In order for EAS to release the test report to you please download and complete the “Release of Information Form”
then fax or mail to EAS.
May I charge for “no shows”, “late cancellations”, or visits not “pre-authorized"?
According to the terms of your contract or agreement with Exclusive Care, you may not charge your client for missed appointments or visits denied due to lack of pre-authorization. “You may only collect from the patient co-pays, deductibles, or co-insurance (if any) as determined by Exclusive Care”. If your client is in arrears for co-payments you can aggressively pursue collecting the unpaid co-payments.
May I bill for group therapy?
Yes you may. Group therapy is a covered CPT code. Pre-authorization is required.
How and when do I refer a client for workers compensation benefits as related to work stressors?
When considering this question, consult with your EAS/Exclusive Care case manager. Case managers are familiar with Riverside County’s culture, workplace policy & procedures and can assist you with assessing the client’s claim to determine if it fits a workers compensation referral. Generally speaking all psychological & medical issues occurring as a result of work could qualify for workers compensation. However, some claims such as “stress” are very difficult to prove which the client may not realize. Educating the client on this may be part of the therapy. Case managers are also familiar with other county programs such as a “Return To Work” program which may fit the client’s needs without initiating worker’s compensation.
When and how often should eligibility be checked?
Employees regularly change jobs, get married, separate from employment. It is the responsibility of the provider to verify eligibility at every visit by calling 1-800-962-1133. For online eligibility click here
Extenuating Circumstances prevented me from obtaining pre-authorization, what do I do?
EAS is a confidential employee benefit of up to 6 counseling sessions per employee and their qualified family member, at no charge.
Call us at 951-778-3970 Riverside Office/ 760-328-6863 Cathedral City Office or email us at firstname.lastname@example.org.