The Holman Group - Provider Manual

Billing/Provider Checklist

Please review this section carefully to facilitate the billing process.

All billing is between The Holman Group and the provider. DO NOT ask your client to call Holman regarding billing procedures. Do not bill the client or the insurance carrier for services rendered.

Authorized EAP/MAP sessions and authorized insurance treatment sessions are billed on a universal billing form.

The Holman Group must have on file copies of the provider’s current licensure and liability coverage (to include expiration date) in order to adjudicate claims and reimburse providers.

NOTE: All services must be pre-authorized. THERE IS NO SUCH THING AS A WALK-IN CLIENT! Clients with benefits through The Holman Group should be encouraged to access their EAP/MAP program by calling the Intake Department. Unauthorized services will not be reimbursed.

The Holman Group will not reimburse a provider for double sessions or more than one session on the same date unless specifically pre-authorized.

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TO BILL FOR AUTHORIZED EAP/MAP SESSIONS:

Submit billing for dates of service for authorized EAP/MAP treatment sessions on a universal Billing form. It is essential that all information requested be complete including employee and/or client data. Providers are to bill on a timely basis. Claims received beyond ninety (90) days after date(s) of service may not be considered for processing.

NO-SHOW/LATE CANCELLATION:

The Provider may bill The Holman Group for no-shows or late cancellations that occur during authorized EAP or free HMO/ ASO carve-out sessions. This amount shall not exceed twenty-five dollars ($25.00). A late cancellation refers to a client who fails to cancel with at least 24 hours advanced notice. The Holman Group will pay for up to two (2) no-show/late cancellation occurrences per benefit year, per enrollee.

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FOR REIMBURSEMENT FOR AUTHORIZED EAP/MAP SESSIONS:

Submit the following completed claim forms to The Holman Group, attention Claims Department:

  • Universal Billing form (HCFA1500/CMS1500 or CMS1450/UB04)
  • Signed Authorization for Release of Information form or indicate signature on file.

Incomplete and/or inaccurate forms will be returned and reimbursement will be delayed.

NOTE: Clinical Assessment Form must be on file with The Holman Group for any claims to be paid.

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TO BILL FOR AUTHORIZED INSURANCE TREATMENT SESSIONS:

Holman HMO
Submit billing for dates of service for authorized HMO treatment sessions on the HCFA or a universal billing form. It is essential that all information be complete including employee and/or patient data. Claims received beyond ninety (90) days after date(s) of service may not be considered for processing.

For reimbursement for authorized HMO treatment sessions, submit the following forms to The Holman Group, attention Claims Department:

  • Universal Billing Form (HCFA1500/CMS1500 or CMS1450/UB04).
  • Signed Authorization for Release of Information form or indicate signature on file.

NOTE: Clinical Assessment Form must be on file with The Holman Group for claims to be paid.

CALIFORNIA LAW PROVIDES THAT ENROLLEES ARE NOT LIABLE FOR ANY AMOUNT OWED BY HOLMAN TO ANY CONTRACTED PROVIDER IN THE EVENT HOLMAN DOES NOT PAY FOR PRE-AUTHORIZED SERVICES AND THAT NO PROVIDER MAY TAKE LEGAL ACTION AGAINST AN ENROLLEE TO COLLECT SUMS OWED BY THE PLAN

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COPAYMENTS:

It is the responsibility of the provider to collect applicable copayments from the client. Copayments are payable to the provider and are deducted from the contracted rates. The provider will not be reimbursed for uncollected copayments.

In the event that the applicable copayment exceeds the provider’s contracted rate, the provider must remit the copayment in full to The Holman Group. The Holman Group will then reimburse the provider at his/her contracted rate.

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PROVIDER REIMBURSEMENT SCHEDULE:

All bills must be submitted in a timely manner. EAP/MAP and HMO provider billings are stamped when received by the Claims Department and will be reimbursed to the provider of service within 30 working days or within the time frame specified by agreement or by law.

UR provider billings are forwarded by The Holman Group to the client’s primary insurance carrier for reimbursement. After payment is received by The Holman Group from the insurance carrier, The Holman Group will reimburse the provider for billed authorized services at the provider’s contracted rate less any applicable copayments. Please note: Any outstanding deductible must be satisfied before the provider will be reimbursed for authorized and rendered insurance treatment sessions.

EAP/MAP and Holman HMO provider billings will be paid by The Holman Group within thirty (30) Working days following receipt of any acceptable, undisputed claim form. Again, any outstanding copayments will be deducted from the provider's contracted rate.

To avoid delays in reimbursement, be sure that billing materials are filled out accurately. The insured’s name, social security number and employer must be clearly identified on the Billing Forms. Complete the requested data on the authorized client as well.

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CHECKLIST FOR BILLING PROCEDURES:

To avoid delays in reimbursement for EAP/MAP services rendered to authorize Holman referred clients:

  1. Make sure The Holman Group has on file copies of your current licensure and liability coverage with expiration dates. We will be unable to pay claims or assign cases without this information.
  2. Complete the Universal Billing Form (HCFA1500/CMS1500 or CMS1450/UB04) for the client’s sessions.
  3. Bill only authorized EAP/MAP sessions. Dates of service must occur within the authorized time period. Do not exceed the number of authorized sessions in a particular authorized time period.
  4. Bill only for authorized client(s).
  5. Make sure the client (or legal guardian) signs and dates the Authorization for Release of Information form.

Submit the above mentioned forms in a timely manner to:
The Holman Group
9451 Corbin Avenue, Suite 100
Northridge, California 91324
Attention: Claims

  1. To receive reimbursement for insurance treatment sessions rendered to authorize Holman referred clients:
  2. Complete the Universal Billing Form (HCFA1500/CMS1500 or CMS1450/UB04).
  3. Bill for authorized client(s) and dates of service only.
  4. Make sure the client (or legal guardian) signs and dates the following (if client had not done so already during his/her EAP/MAP sessions[s]): Authorization for Release of Information form.
  5. Collect from the client any applicable deductible. Again, an EOB from the client’s insurance carrier is the only reliable proof that the deductible, or a portion thereof, has been satisfied.
  6. Collect and keep copayments and deductibles.
  7. Submit the above mentioned forms, if applicable, in a timely manner to:
    The Holman Group
    9451 Corbin Avenue, Suite 100
    Northridge, California 91324
    Attention: Claims

FRAUD INVESTIGATION

If a Provider knows or suspects illegal or wrongful billing practices by an Enrollee or a Provider, the Provider should notify The Holman Group immediately. Any information provided will be treated with strict confidentiality. Call 1(800)321-2843, and speak with the Holman Group’s Finance Manager.

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