A guide to
providing services
44.20.801.1 F (7/14)
Aetna Behavioral Health
Aetna Resources For Living
SM
Employee Assistance Program (EAP)
Quality health plans & benefits
Healthier living
Financial well-being
Intelligent solutions
Table of contents
Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies.
The EAP is administered by Aetna Behavioral Health, LLC, Horizon Behavioral Services, LLC, Resources For Living, LLC,
Aetna Health of California Inc., and Health and Human Resources Company, Inc. (Aetna).
An introduction to the Aetna EAP, Aetna Resources For Living 3
Our philosophy
The Aetna Resources For Living structure
Why participants value Aetna Resources For Living
Clinical information 4
Call center
Aetna Resources For Living clinical staff
Call center access and hours of operation
Referral process
Follow-up
Our approach
Threat of harm
Coordination of care
Access standards
Performance-based referrals for job-related substance abuse issues
Additional services available to participants
Program quality assurance and improvement 7
Quality standards
Confidentiality
Participant grievances
Provider relations 9
Provider credentialing and recredentialing
Nondiscrimination
Notice of status changes
Aetna Resources For Living website
EAP provider satisfaction survey
Aetna Resources For Living plan designs 10
Reimbursement 11
What you will receive
What you need to submit
What you need to know
Appeal process
In conclusion
2
3
An introduction to the Aetna EAP,
Aetna Resources For Living
We developed Aetna Resources For Living in response to the
needs of our plan sponsors (employers) and members. Aetna
Resources For Living is a comprehensive well-being approach
and resource designed to empower our members to
proactively take charge of their lives.
We believe Aetna Resources For Living is an important
element of our benefits plan offerings because of the unique
services it offers our members.
Our philosophy
At Aetna, we believe in an integrated, holistic approach to
health and well-being, where our program is part of an overall
continuum of care. Aetna Resources For Living is designed to
help improve productivity, increase employee satisfaction
and better manage health costs.
Our program can serve as the early point of intervention for
many problems and issues that can affect a member’s
physical and mental well-being. We partner with our
members to address work and life issues before they become
unmanageable.
Aetna Resources For Living offers a full suite of services to
meet the personal needs of members and the business needs
of the workplace. Standard program offerings include:
•24/7 access to trained mental health professionals
•Assessment and referral services
•Face-to-face counseling sessions delivered in a variety
of program session models
•Training and education services
•Management consultation
•Critical incident support
•Interactive web services
•Communication and promotion tool kit
•Reporting services
•Work/life services, including elder care, child care and
legal/financial resources
The Aetna Resources For Living structure
The Aetna Resources For Living operations unit is
headquartered in Hartford, CT. We have developed a national
network of EAP providers to service our business across the
country. Our Aetna Resources For Living operations are
modeled on the Council on Accreditation standards for EAP
program accreditation. We have select vendor arrangements
for services such as work/life balance, crisis management and
international EAP referral.
Why participants value Aetna Resources For
Living
Aetna Resources For Living is designed to be an inviting and
dynamic program with features that make it a valuable
resource members will want to use. The program features
easy and confidential access to both telephone and
web-based services, so members can quickly find the
resources they need.
We have leveraged our long-standing history as a leader and
innovator of health-related programs and services to
integrate Aetna Resources For Living into an overall
well-being strategy. When members use our program, we
assess their needs and guide them to resources that can best
meet their needs. Aetna Resources For Living may be able to
help them solve a small problem early on before it becomes a
major concern, as well as encourage the appropriate use of
behavioral health and medical benefits.
Participant benefits
•A supportive environment to balance work and life
issues: Aetna Resources For Living provides resources for
members and their entire households to help them deal
with such issues as marital difficulties, substance abuse and
workplace conflicts, as well as general work/life concerns
such as elder care, child care, and legal and financial
concerns.
•Easy access that saves time and effort: Members can
access the program conveniently and confidentially, 24
hours a day, 7 days a week. Whether by phone or via the
Internet, they are quickly directed to the resources they
need. This can help them efficiently and effectively
manage issues that ordinarily would require substantial
time and effort.
•Personalized service: One phone call to the toll-free
number puts members in touch with trained professionals
who can assess their needs and recommend an appropriate
course of action.
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The primary purpose of Aetna Resources For Living is to
provide confidential and timely assistance to members and
all the members of their households who are experiencing
personal problems that may affect job performance. Adult
dependents up to age 26, regardless of where they live, are
also covered, unless there are more generous state
requirements. Issues may include, but are not limited to:
•Family and marital discord
•Depression and stress management
•Financial problems
•Grief and bereavement
•Substance abuse
•Gambling and other compulsive behaviors
Members and their families can receive a predetermined
number of counseling sessions at no direct cost to the
participant, such as a copayment or deductible. The
employer determines the number of sessions.
Call center
The Aetna Resources For Living call center has multiple
locations: San Diego, CA; Denver, CO; Sandy, UT; Arlington,
TX; Austin, TX; Hartford, CT; and Fairfield, CT.
Our call center is staffed with customer service professionals
and EAP clinicians. This group is supported by a team of call
center managers, trainers, and quality improvement and
system support personnel.
We have Spanish-speaking customer service staff to assist
members. In addition, Aetna has full use of Voiance
translation services. We’re able to accommodate over
200 languages in the Voiance repetoire.
Aetna Resources For Living clinical staff
The role of the Aetna Resources For Living clinical staff is
to function as a consultant to the caller regarding his or her
presenting problem or issue.
The clinical staff are generally licensed behavioral health
clinicians with three plus years of EAP and/or work/life
experience. A master’s degree in the social sciences is
required, with certification in EAP and CEAP* preferred. We
look for dedicated individuals who are willing to get the job
done — and done well — while showing discretion and
sensitivity.
The Aetna Resources For Living clinical team is supported by
professionals with many years of experience in the delivery of
EAP services.
Aetna Resources For Living clinical staff and our Provider
Relations department work constantly to maintain
information on local resources. This includes 12-step
meetings, support groups, community services provided
through hospital systems and local health providers. We are
in contact with our EAP provider network as well, and we
work with them to identify the best of what is being created
in the community.
Aetna Resources For Living offers a variety of programs to
our plan sponsors (employers), geared toward meeting the
unique needs of the corporate culture and employee
population.
Call center access and hours of operation
Members receive a toll-free number to access the Aetna
Resources For Living call center, which is staffed 24 hours
a day, 365 days a year by Aetna’s customer service
professionals and clinical staff. Aetna does not use an
answering service.
Referral process
The Aetna Resources For Living member intake process is
part of our proprietary service delivery model. The process
includes use of evidence-based, clinically tested intake tools
to measure the member’s level of distress and refer him or
her to the most appropriate service. We also collect the
caller’s geographic requirements and preferences and verify
the level of benefits available through his or her plan.
Clinical information
* The Certified Employee Assistance Professional (CEAP) credential was created in 1986 to identify those individuals who have met
established standards for competent, client-centered practice and who adhere to a professional code of conduct designed to
ensure the highest standards in the delivery of employee assistance services. The CEAP credential is now recognized by
employers, human resources professionals, accrediting agencies and employees as the standard in employee assistance. The
Employee Assistance Certification Commission administers the CEAP recredentialing process.
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When face-to-face services are appropriate, the Aetna
Resources For Living staff will arrange referrals. The staff
searches Aetna’s extensive database for suitable providers
based on the member’s service request and presentation.
Aetna Resources For Living staff offers several appropriate
providers to the member.
After choosing a provider and prior to the member’s first
appointment, he or she must obtain EAP authorization. This
authorization is sent directly to you. If you have not received
the authorization from Aetna, please contact us.
In some cases, according to plan sponsor specifications, a
member will be offered the option to have us facilitate
making the appointment with the provider. Or if callers prefer,
they may make that outreach/appointment on their own.
In addition to face-to-face counseling, EAP telephone
counseling is an option when clinically appropriate and a
good choice for your client. You determine if counseling by
phone is clinically appropriate when you discuss this option
with your client.
Follow-up
Aetna Resources For Living offers to follow up with members
to ensure their needs have been met and to determine their
satisfaction with services. Callers with emergent needs will
receive a follow-up call within 24 hours. All crisis calls are
followed up by telephone the following day to ensure
adequate treatment. Callers with urgent needs will receive
a follow-up call within 48 hours. Finally, when the call is for
a performance-based referral or management request,
follow-up with the provider will be done at specified intervals,
depending upon industry need.
Network providers who require additional assistance for
members using the program can call us for referrals,
resources or follow-up services.
Our approach
Aetna Resources For Living provides a holistic assessment
that looks across multiple areas of an individual’s or
household’s functioning. This assessment identifies needs
and opportunities and, in partnership with the member(s),
leads to development of a plan to achieve goals.
When short-term, solution-focused intervention is a
component of this benefits plan, the Aetna EAP network
provider pursues this work directly with the member. The
Aetna EAP network provider takes on the role of case manager
when helping the member address needs and opportunities
beyond the scope of short-term, solution-focused therapeutic
interventions. For these elements of the plan, the Aetna EAP
network provider is expected to assist in identifying resources
and linking the client.
The Aetna Resources For Living call center can assist in this
process. Often members will have a suite of services available
to them through their EAP benefits, such as legal, financial
and/or work/life services. They may also have access to
specialized behavioral health, wellness, disease management
and other programs as a part of their behavioral health and
medical benefits. The Aetna Resources For Living call center
will identify and link members to some of these additional
benefits programs and community resources.
Threat of harm
Callers who pose an imminent threat to themselves or others
are handled as emergent callers, and interventions are made
accordingly. Emphasis is placed on ensuring the safety of the
caller and others. Aetna Resources For Living will provide
immediate access to services including, but not limited to,
keeping the caller on the line while police or other emergency
personnel are called. If that notification is appropriate, Aetna
follows all federal, state and professional regulations.
In your role as an Aetna EAP network provider, if you identify
member issues that in your professional, clinical judgment
represent a threat of harm to the individual member or others
(including those in the workplace), we expect that you will
follow all applicable state laws and regulations, as well as
professional guidelines related to threats of harm, including
notification requirements.
Coordination of care
Coordination of care between the Aetna EAP network
provider and treating physicians, including primary care
physicians and/or behavioral health specialists, may be
critical to ensuring the quality of the health services the
member receives. Relevant member information will be sent
or shared with appropriate health care professionals with
proper authorization within a reasonable time frame.
Providers will weigh the clinical urgency of sharing vital
patient information with other professionals when deciding
how soon to forward the information.
Aetna Resources For Living does not provide inpatient
treatment. Members requiring inpatient treatment are
serviced through their behavioral health benefits plan.
Therefore, members requiring long-term behavioral
health case management are best managed through
the medical/behavioral health benefits plan.
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Access standards
As outlined in your Aetna EAP Provider Agreement (contract),
Aetna Resources For Living’s standards for access to provider
appointments are:
•Five business days for routine requests
•Within 24 hours for urgent situations
•Same day for emergencies (or where medical or law
enforcement intervention is required)
In addition, we expect the in-office waiting times not to
exceed 15 minutes past the scheduled appointment time.
Aetna recognizes that network providers have varied
appointment availability, particularly with after-hours care.
Since many of our members are actively employed, evening
and weekend appointment availability is important. We
strongly encourage providers to offer a variety of
appointment options.
Performance-based referrals for job-related
substance abuse issues
When assessing on-the-job substance abuse issues,
Aetna Resources For Living considers the corporate culture,
worksite and work group dynamics, in addition to the nature
and circumstances of the event itself, before designing a
solution.
If a referral to an Aetna EAP network provider is appropriate,
the Aetna Resources For Living clinician contacts the provider
to make a first appointment and brief the provider on the
particulars of the case and our follow-up expectations. If an
employee requires treatment because of a corporate policy
violation, the Aetna Resources For Living clinician reviews
the employer’s protocols for corporate policy violation, for
example, a positive drug screening or an attendance problem.
Typically, the employee’s supervisor would contact the
Aetna Resources For Living call center to initiate the
mandatory referral process. Aetna Resources For Living will
then track the case from initial contact by the employee,
through assessment and evaluation, to referral and provision
of clinical services by a network provider, to monitoring
of compliance with recommended interventions and
case closure.
All appropriate information release forms must be completed
at the initiation of the referral process. If the appropriate
release of information is obtained, the Aetna EAP provider
assigned to the case would maintain contact with the
supervisor, human resources, medical or other company
designee, or the state regulatory body involved (for example,
the Department of Transportation), as determined by the
unique case needs. In the event of a mandatory referral to
the EAP, and with the proper release of information forms
signed, Aetna Resources For Living will confirm compliance
(or lack of compliance) with the recommended treatment.
Additional services available to participants
Aetna Resources For Living offers eligible members resources
and information to help balance work, family and personal
issues. During the course of treatment, Aetna EAP network
providers may contact Aetna Resources For Living if the
member (if eligible) would benefit from services such as:
•Child and adult care resource and referral
•Legal and financial consultations and referral
•Everyday and personal referrals, such as basic needs,
college planning, pet care and more
•Access to information on numerous work and life issues
Our specialists will provide a comprehensive consultation
with the member to assess his or her needs and determine
the appropriate services that may meet the needs. After the
initial call, research will begin immediately, and specific
resources will be identified to meet the member’s needs —
including cost, location and any other special requirement.
Research includes calling each potential service provider and
confirming the availability of services, saving the member
a great deal of effort and time.
Following each request and assessment, the member receives
several customized referrals and informational materials to
help him or her make a decision about which service to
choose. Our specialists follow up to ensure that the
information and referrals met the member’s needs and will
perform additional research if needed.
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Quality standards
Aetna Resources For Living has developed quality standards
that ensure an optimal process for a successful EAP. We
continually track numerous quality indicators and any
deviations from accepted standards across all our call
centers. By instituting a program of continuous quality
improvement, we consistently evaluate and adapt our
processes to provide world-class service delivery.
Confidentiality
Confidentiality is a critical predictor of EAP success. All
provider contracts require that providers agree to comply
with Aetna’s confidentiality policy. We have woven
confidentiality into all aspects of the Aetna Resources For
Living EAP. Some additional examples include:
•Careful selection of the exact physical location of the Aetna
Resources For Living staff to eliminate others overhearing
information.
•Separation of the Aetna Resources For Living
documentation system from other Aetna documentation
systems so that persons outside of Aetna Resources For
Living cannot access any EAP data.
•The production of reports only at the plan sponsor level,
with no information produced at the employee level.
•Extensive training for all Aetna Resources For Living staff on
confidentiality. Aetna Resources For Living staff have access
to member information limited to their need to know in
order to perform their job.
While quality services delivered by Aetna EAP network
providers are the cornerstone of a successful EAP program,
it is crucial that complete confidentiality is maintained at all
times. As such, Aetna Resources For Living oversees provider
services in a number of ways. We have already-established
standard documentation guidelines for behavioral health
records that also apply to EAP records.
These guidelines for providers allow Aetna-employed staff to
request a sample of your records and audit them against our
standards. We will give direct feedback to the Aetna EAP
network provider where opportunities for improvement can
be addressed. In addition, we will track and use results,
complaints, compliments or other comments regarding
Aetna EAP network providers at the time of recredentialing.
Of course, serious concerns will be addressed immediately.
Participant grievances
While Aetna anticipates the service provided to members to
be such that the number of complaints and grievances should
be very low, member feedback provides valuable information
about how we can improve our services. Aetna Resources For
Living complies with the rigorous standards of the Aetna
complaint and appeal policy, which was developed to:
•Identify and manage member complaints and appeals to
resolution
•Collect data for reporting and evaluating member
satisfaction
•Implement action plans to improve member satisfaction
•Meet requirements for legal, regulatory and accreditation
standards
This policy offers members a means to improve access to
quality services and improve customer satisfaction by
providing a consistent, organized and timely system to
address and resolve their concerns. We provide a mechanism
for members, directly or through an authorized
representative on their behalf, to express and resolve
concerns and disagreements regarding services, benefits,
participating providers and administrative contract policies.
The process for registering receipt of and responding to
verbal and written complaints and appeals includes the
following:
•Documentation of the substance of the complaint or
appeal, and the action taken
•Full investigation of the substance of the complaint or
appeal, including any aspect of service or quality of care
involved
•Notice to the member of the disposition of the complaint or
appeal and the right to further levels of appeal, as
appropriate
•Standards for timeliness
Program quality assurance and improvement
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When a member (or authorized representative on behalf of
the member) initiates contact that includes a verbal or written
expression of dissatisfaction/concern, it will be considered a
complaint in the following circumstances:
•The member expresses dissatisfaction with the direct
provision or quality of care by an EAP provider.
•The participant expresses dissatisfaction with the quality
of administrative services provided by Aetna Resources
For Living.
When the complaint is resolved by the Aetna Resources For
Living staff, the substance of the complaint; the investigation,
including any aspects of services involved (for example, the
member’s concerns regarding the responsiveness or quality
of the services provided); and resolution are documented in
the Aetna Resources For Living system. If the complaint is not
resolved to the member’s satisfaction by the Aetna Resources
For Living staff using their own resources, Aetna will triage
the concern to Aetna Resources For Living management for
further review.
Member complaints are investigated and resolved with notice
of the disposition of the complaint to the participant within
30 calendar days of receipt of the complaint. The member is
advised of his or her right to pursue further resolution of the
complaint as appropriate.
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Our goal is to create a collaborative relationship with you
and all of our participating providers. We are committed to
assisting you in understanding the policies and procedures
to follow in providing high-quality services to our Aetna
Resources For Living members. The Aetna Resources For
Living staff is available to assist you with authorization
procedures, claims payment and other important processes,
as outlined in the provider agreement/contract. From time
to time, we may amend these policies or implement new
policies and procedures. In such instances, we will give you a
minimum of 30 days’ notice regarding any new requirements.
Provider credentialing and recredentialing
Our Aetna Resources For Living provider network is made
up of licensed professionals in the fields of psychology,
psychiatric nursing, clinical social work, marriage and family
counseling, and chemical dependency. These licensed
clinicians may also be certified through the Employee
Assistance Professionals Association or the Substance Abuse
Program Administrators Association, as well as other
behavioral health certifications. We encourage our Aetna
Resources For Living providers to seek CEAP credentialing
whenever possible. Credentialing providers with a wide array
of specialties ensures we are able to meet the diverse needs
of the members and companies we serve.
Once a provider joins the Aetna Resources For Living provider
network, he or she is required to be recredentialed every
three years, except where state law or regulations mandate
recredentialing more frequently. Credentialing information
must be current and not older than 180 days at the time of
the credentialing/peer review decision.
The required file documentation includes:
•Application, including information on licensure and
certification
•Attestation
•Committee decision regarding results of file review
•Committee decision date
•Primary verification evidence (in the United States only)
•Malpractice history
•Information regarding loss, sanction, limitation of licensure,
Drug Enforcement Administration certification,
participation in a Medicare or Medicaid provider network or
U.S. Office of Personnel Management programs
•History of medical conditions or substance abuse
•Results of office assessments and any re-reviews
(where applicable)
•Results of quality improvement activities (as applicable)
or other performance monitoring
•Member complaints
Nondiscrimination
In no instance would Aetna limit or deny participation to any
provider due to reasons of age, race, gender, color, religion,
national origin, ancestry, disability, marital status, sexual
orientation or any characteristic protected under state,
federal or local law. In addition, no provider would be
terminated due to advocating on the member’s behalf.
Notice of status changes
You are required to notify Aetna Resources For Living within
14 days, either by telephone or in writing, of any changes
related to the following:
•Change in professional liability insurance
•Change of practice location, billing location, telephone
number or fax
•Status change of professional licensure, such as suspension,
restriction, revocation, probation, termination, reprimand,
inactive status or any other adverse situation
•Change in tax identification number used for claims filing
•Malpractice event
•Change in availability of office hours or after-hours
coverage or an extended vacation
Mail correspondence regarding changes to:
Aetna Behavioral Health
1425 Union Meeting Road
PO Box 5
Blue Bell, PA 19422
Or fax to:
Attn: Aetna EAP Provider Relations
at 860-907-4337
Direct your questions to:
Aetna EAP Provider Relations
telephone line at 1-888-632-3862
(between 8 a.m. and 5 p.m. ET)
Provider relations
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Aetna Resources For Living online
This manual and all Aetna Resources For Living forms
are posted on our public website at www.aetna.com.
To view this manual, under the “Health Care Professionals”
section, choose “Education & Manuals” from the top menu,
then “Provider Manuals.”
We’ve also posted these Aetna Resources For Living forms
under the “Health Care Professionals” section. Choose
“Health Care Professional Forms” from the top menu, then
select the EAP forms row.
•Dispute Resolution Request form
•Dispute Resolution Request form — California
•Statement of Understanding
EAP provider satisfaction survey
Periodically, we will conduct a provider satisfaction survey
to help us better understand the provider experience
when interfacing with our customer service, clinical, claims
and provider relations staff. We will contact you by mail to ask
a few questions about Aetna Resources For Living and its
administrative and clinical aspects, giving you the
opportunity to provide us with important feedback about
the program.
Aetna Resources For Living
plan designs
Aetna Resources For Living provides support and
resources to members and their families in dealing
with diverse issues. These include substance abuse,
workplace conflict and marital distress, as well as
other work/life issues such as elder care, child care,
and legal and financial concerns.
Typical plan designs include:
•Telephone assessment and referral
•Three-, five-, six- and eight-session models
for short-term intervention
What you will receive
Prior to the member’s first visit, you will receive a
member-specific authorization/billing form that is populated
with this information:
•Member’s name
•Member’s date of birth
•Authorization number
•Number of EAP sessions available
• Effective date range of the authorization
What you need to submit
Aetna Resources For Living is committed to providing prompt
payment to our providers for EAP services rendered. We strive
to process 100 percent of all claims within 30 days of receipt.
To process your claim promptly, it is imperative that you
complete the billing form in its entirety upon completion of
EAP services.
Please submit your completed billing form to the address or
fax number located at the bottom of the form. It must be
submitted within 90 days from the last date of service. If
claims are submitted after the timely filing limit, they will be
denied for payment.
What you need to know
•Reimbursement is based upon your EAP contractual rate.
•Reimbursement is for one session per day (45 – 60 minutes).
•Aetna does not reimburse “no show” sessions. “No show”
sessions can only be billed to the member if the member
signed an agreement to allow you to do so.
•Do not bill the member for EAP services rendered under
any circumstances.
•Authorizations are not transferable to another provider
or member.
Note: To receive reimbursement for telephone
counseling, just place a “Y” in the telephonic section
of the authorization/billing form.
Please direct your billing
questions to 1-800-872-7322
or 1-800-890-1921
(CA providers only).
Appeal process
If you believe your claim was denied in error, please send your
request for appeal, along with the supporting information
that shows the claim was submitted on time, to the address
on your remittance statement. We must receive appeals in a
timely manner in order to review them for reconsideration.
Refer to the disclosure statement at the bottom of your
remittance statement for timely filing guidelines.
In conclusion
Thank you for becoming part of the Aetna Resources For
Living network. Because of the skills and experience you and
our other providers offer, Aetna Resources For Living
members can receive meaningful support services that can
help make a difference in their lives. Your inclusion in the
Aetna Resources For Living network gives members access to
the assistance they need to better deal with behavioral health
and/or workplace issues.
Reimbursement
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All calls are confidential, except as required by law (i.e., when a person’s emotional condition is a threat to himself/herself or others,
or there is suspected child, spousal or elder abuse, or abuse to people with disabilities).
www.aetna.com
©2014 Aetna Inc.
44.20.801.1 F (7/14)
