Medical Billing Terms E: EAP Billing, EHR and Eligibility Terms

EAP billing terms describe how practices get authorized and paid by employee assistance programs. This page defines the EAP terms and the others from EAP authorization to EMR, including EHR, EDI, EFT enrollment and eligibility verification. Each entry gives a plain definition, why it matters, an example, and an official source. MCM South Medical Billing Service, LLC works only in mental and behavioral health billing.

Last reviewed: October 10, 2026Sources linked at each term

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Billing Terms Glossary slide, Terms E: EAP billing terms - MCM South Medical Billing Service, LLC

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On this page (18 terms)

EAP Authorization
EAP Vendor
ECHO Health
eClinicalWorks
Effective Date
EFT Enrollment
EHR (Electronic Health Record)
Electroconvulsive Therapy (ECT)
Electronic Data Interchange (EDI)
Electronic Funds Transfer (EFT)
Elevance Health
Eligibility Denial
Eligibility Verification
Eligibility Verification Tool
E/M Code
Emancipated Minor
Employee Assistance Program (EAP)
EMR (Electronic Medical Record)

How to use these EAP billing terms definitions

Use this page as a quick reference for EAP billing terms, from EAP Authorization to EMR. Each entry gives a plain definition, why it matters to a mental health practice, and an official source. When a rule changes by payer or state, the entry says so, so confirm EAP billing terms details with the payer before you bill.

Checklist: put the eap billing terms definitions to work

Check the eap billing terms entries above before you send a claim that depends on them.
Share this eap billing terms page with front-desk and billing staff so everyone works from the same definitions.
When a payer letter mentions eap billing terms, find the matching entry and note the date you checked it.
Keep your eap billing terms notes next to your payer contracts, because a contract can define a term differently.
Ask the payer to confirm in writing how it applies eap billing terms before you change a workflow.
Train new staff on eap billing terms first, then move on to the rest of the glossary.
Log any eap billing terms question that comes up twice, then add the answer to your billing procedures.

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EAP Authorization

Private payer

Also called EAP authorization letter; EAP referral

Definition: A vendor's approval for a set number of EAP sessions with a named provider, usually required before the first session.
Why it matters: Sessions without an authorization are commonly denied or unpaid.
Illustrative example: A therapist confirms an authorization number and session count before scheduling.

Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesBehavioral Health Specific Terms Prior Authorization Terminology

EAP Vendor

Private payer

Also called EAP network; EAP administrator

Definition: A company that administers EAP benefits for employers, including authorization and payment to network clinicians.
Why it matters: Each vendor has its own credentialing, claims process, and eligible clinician rules.
Illustrative example: A clinician joins an EAP vendor's panel separately from health plan networks.

Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesBehavioral Health Specific Terms BCBS, UHC & Commercial Payer Terms

ECHO Health

General (all payers)

Also called ECHO; Echo Health payments; ECHO payments

Definition: A health care payments company that delivers payments and remittances between payers and providers, including virtual card and EFT. Listed for reference; not an endorsement or partnership.
Why it matters: Payers using ECHO may pay by virtual card unless the provider enrolls in EFT.
Illustrative example: A provider enrolls in ECHO EFT to avoid card fees.

Reference sourceECHO Healthchecked 10/9/26

CategoriesPayment & Reimbursement

eClinicalWorks

General (all payers)

Also called eCW

Definition: A vendor of EHR and practice management software for ambulatory practices. Listed for reference; not an endorsement or partnership.
Why it matters: Used across many outpatient practices.
Illustrative example: A practice bills from eClinicalWorks.

Reference sourceeClinicalWorkschecked 10/9/26

CategoriesEHR & Healthcare Technology Terms

Effective Date

General (all payers)

Also called network effective date; participation effective date

Definition: The date a clinician's in-network participation with a payer officially begins. Claims for earlier dates of service are usually not payable in-network.
Why it matters: It defines which sessions can be billed in-network and which cannot.
Illustrative example: A payer approves a therapist on March 10 with an effective date of April 1; March sessions cannot be billed in-network.

Reference sourceNCQAchecked 10/9/26

CategoriesCredentialing & Enrollment Contracting & Network Management

EFT Enrollment

General (all payers)

Also called EFT registration; ERA/EFT enrollment

Definition: The process of registering a provider's bank account and EDI details with a payer to receive electronic payments and remittances.
Why it matters: Missing enrollment means paper checks and manual posting.
Illustrative example: A practice enrolls in ERA and EFT with each payer.

Reference sourceX12checked 10/9/26

CategoriesPayment & Reimbursement EDI & Clearinghouse Terms

EHR (Electronic Health Record)

General (all payers)

Also called EHR; electronic health record system; EHR software

Definition: Software that stores a patient's clinical record, including notes, diagnoses, medications, and orders, and often includes scheduling and billing features.
Why it matters: The EHR is the source of documentation that supports claims and audits.
Illustrative example: A therapist writes a progress note in the EHR and the system generates the claim.

Reference sourceHHS (U.S. Department of Health and Human Services)checked 10/9/26

CategoriesEHR & Healthcare Technology Terms

Electroconvulsive Therapy (ECT)

General (all payers)

Also called ECT; 90870

Definition: A psychiatric treatment delivered under anesthesia, billed with specific codes and often involving facility and professional claims.
Why it matters: Requires authorization and coordination of professional and facility billing.
Illustrative example: A hospital bills facility fees while the psychiatrist bills professional fees.

Related termsCPT Code Prior Authorization

Reference sourceAmerican Medical Association (AMA)checked 10/9/26

CategoriesBehavioral Health Specific Terms Claims Processing

Electronic Data Interchange (EDI)

General (all payers)

Also called EDI; electronic transactions

Definition: The structured electronic exchange of business data, including claims, eligibility, and remittance, between providers, clearinghouses, and payers.
Why it matters: EDI is the backbone of claim submission and payment.
Illustrative example: A practice sends 837P files and receives 835 remittances.

Reference sourceX12checked 10/9/26

CategoriesEDI & Clearinghouse Terms

Electronic Funds Transfer (EFT)

General (all payers)

Also called EFT; direct deposit; electronic payment

Definition: An electronic transfer of payment from a payer to a provider's bank account.
Why it matters: EFT enrollment is required by many payers and must match the ERA to reconcile.
Illustrative example: A payer sends an EFT that a biller matches to an ERA.

Reference sourceX12checked 10/9/26

CategoriesPayment & Reimbursement EDI & Clearinghouse Terms

Elevance Health

Private payer

Also called Elevance; formerly Anthem, Inc.

Definition: The health company, formerly Anthem, Inc., that operates Anthem-branded Blue plans and other health services businesses.
Why it matters: Explains the corporate name change from Anthem, Inc.
Illustrative example: A payer letter comes from Elevance Health.

Reference sourceElevance Healthchecked 10/9/26

CategoriesBCBS, UHC & Commercial Payer Terms

Eligibility Denial

General (all payers)

Also called no coverage denial; inactive coverage denial

Definition: A denial because the payer says the patient was not covered on the date of service.
Why it matters: Prevented by verifying eligibility before each visit and checking for retroactive changes.
Illustrative example: A claim denies for coverage terminated before the date of service.

Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesDenials & Appeals Eligibility & Benefits

Eligibility Verification

General (all payers)

Also called eligibility check; insurance verification; benefits verification

Definition: Confirming, before service, that a patient has active coverage and learning what the plan covers, including cost sharing and visit limits.
Why it matters: The first step to preventing eligibility denials and patient billing surprises.
Illustrative example: Front desk runs an eligibility check the day before an appointment.

Reference sourceCMS (Centers for Medicare & Medicaid Services)X12checked 10/9/26

CategoriesEligibility & Benefits

Eligibility Verification Tool

General (all payers)

Also called eligibility tool; insurance verification software

Definition: Software that automates eligibility checks through real-time transactions or payer portals.
Why it matters: Reduces manual checks and eligibility denials.
Illustrative example: A tool checks eligibility for the next day's schedule.

Reference sourceCAQHchecked 10/9/26

CategoriesEHR & Healthcare Technology Terms Eligibility & Benefits

E/M Code

General (all payers)

Also called E/M; evaluation and management; office visit code

Definition: A CPT code for office or other outpatient visits that assesses and manages a patient's condition. Psychiatrists use E/M codes for medication management visits.
Why it matters: Psychiatrists bill E/M codes; psychotherapists usually bill non-E/M psychotherapy codes.
Illustrative example: A psychiatrist bills an established-patient E/M for a medication visit.

Reference sourceAmerican Medical Association (AMA)checked 10/9/26

CategoriesClaims Processing Behavioral Health Specific Terms

Emancipated Minor

State law (varies by state)

Also called emancipation; emancipated youth; minor with adult legal status

Definition: An emancipated minor is a person under the age of majority whom the law treats as an adult for certain purposes, such as consenting to their own health care. Common paths include active military duty, marriage, or a court order.
Why it matters: The paths and the rights that follow vary by state. In Georgia, for example, an emancipated minor may authorize their own mental health care without parental knowledge or liability. Keep a copy of the court order or other proof in the record.
Illustrative example: A 17-year-old provides a court emancipation order at intake, and the practice records it before treating the patient as the consenting adult.

Reference sourceNational Center for Youth Law, Minor Consent Compendium 2024: Georgiachecked 10/9/26

CategoriesAudits & Compliance Behavioral Health Specific Terms

Employee Assistance Program (EAP)

Private payer

Also called EAP; EAP benefit; EAP sessions

Definition: An employer-sponsored program offering short-term counseling and referrals, usually with a set number of sessions at no cost to the employee.
Why it matters: EAP billing differs from standard insurance: separate networks, authorization letters, and payers.
Illustrative example: An EAP authorizes six sessions and the therapist bills the EAP vendor, not the health plan.

Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesBehavioral Health Specific Terms BCBS, UHC & Commercial Payer Terms

EMR (Electronic Medical Record)

General (all payers)

Also called EMR; electronic medical record

Definition: A digital version of a patient's chart within one practice; the term is often used interchangeably with EHR.
Why it matters: Same operational role as an EHR for billing and documentation.
Illustrative example: A small practice keeps notes in an EMR.

Reference sourceHHS (U.S. Department of Health and Human Services)checked 10/9/26

CategoriesEHR & Healthcare Technology Terms

Quick answer: EAP billing terms

What is an Employee Assistance Program (EAP)?

Employee Assistance Program (EAP) is an employer-sponsored program offering short-term counseling and referrals, usually with a set number of sessions at no cost to the employee. EAP billing differs from standard insurance: separate networks, authorization letters, and payers.

Frequently asked questions: EAP billing terms

What is an EAP authorization?

EAP Authorization is a vendor's approval for a set number of EAP sessions with a named provider, usually required before the first session. Sessions without an authorization are commonly denied or unpaid.

What is eligibility verification?

Confirming, before service, that a patient has active coverage and learning what the plan covers, including cost sharing and visit limits. The first step to preventing eligibility denials and patient billing surprises.

What is EFT in medical billing?

Electronic Funds Transfer (EFT) is an electronic transfer of payment from a payer to a provider's bank account. EFT enrollment is required by many payers and must match the ERA to reconcile.

Related resources

Where MCM South works

MCM South serves psychotherapists and psychiatrists in ten states: Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois.

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