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EAP Billing Form & Instructions Updated August 17, 2018
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Please click this link below to fill out the EAP Billing Form to submit for payment.

EAP BILLING SUBMISSION

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
380 E. Parkcenter Blvd., Ste. 300
Boise, ID 83706

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.

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

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EAP Separate Incident Request Form, Instructions & FAQ Updated December 3, 2018
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Please click on the link below to complete a Separate Incident Request for a client or their family member.

EAP Separate Incident Request Form

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Automatic Deposit Sign-up Form Updated August 31, 2018
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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.

AUTOMATIC DEPOSIT SIGN-UP

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W-9 Form Updated November 21, 2018
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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

 

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