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EAP Billing Form & Instructions Updated August 17, 2018

Please click this link below to fill out the EAP Billing Form to submit for payment.


How to file a claim

Click on the link provided above, or the red down arrow icon. All claims must be submitted within 60 days from the date of service. Claims submitted after 60 days will be denied. BPA Health will accept claims either as an uploaded CMS (HCFA) 1500 form or by filling in the requested information.

In addition, you may fax forms to 208-344-7430 to the attention of the Claims Department or mail them to:
BPA Health
Claims Department
8050 W Rifleman St., Ste 100
Boise, Idaho 83704

For questions, please contact the Claims Department at 800-486-4372 or 208-947-1290.

Claims submitted with insufficient information will be returned and may be re-submitted after they have been
corrected. All clean claims will be processed within 30 days.

EAP/BH Provider Information Update Form Updated September 19, 2016

With this form you can add or remove addresses/locations, update office operations, upload a new W-9, change specialties, and request to transfer clients.

EAP/BH Provider Information Update Form

EAP Separate Incident Request Form, Instructions & FAQ Updated December 3, 2018

Please click on the link below to complete a Separate Incident Request for a client or their family member.

EAP Separate Incident Request Form

Leave Our Networks Updated March 6, 2019

If you would like to be removed from the EAP or SUD Networks, please complete this brief form.

Automatic Deposit Sign-up Form Updated August 31, 2018

If you are an SUD Agency or EAP-BH Provider with BPA Health, we will electronically transfer funds directly into your account if you would like. Signing up for automatic deposits, also ensures a quicker turn-around time for you to receive your funds.

To sign up, please click below or click on the arrow above.


Adverse Event Reporting Form Updated July 9, 2020

All providers are required to report to BPA Health within 24 hours any incident or event that threatens the safe and efficient operations of BPA Health or any contracted provider, involving a client who received authorized services within the last thirty (30) days. Failure to comply with reporting requirements may result in sanctions.

The Adverse Event Reporting form can be accessed here.

A list of reportable events can be found here:

BPA Health may follow-up on adverse events for additional information.


W-9 Form Updated November 21, 2018

Request for taxpayer identification number (TIN) for reporting on an information return (e.g., 1099-MISC) the amount paid.

Click here for W-9 fillable form


Behavioral Health Provider Initial Application Form-Sample Updated September 26, 2018

This is a sample form to allow the provider to preview what information is required before completing the form.  To view the blank form, please click the download button.  To fill out the online form, please click here.