Affiliate Manual

As an affiliate for Workplace Solutions, we ask that you contact the client to schedule the initial appointment unless otherwise indicated. As stated in our affliate manual, we ask that the initial appointment be held within 4 (four) business days of our initial contact with you.

***IMPORTANT***
Please notify Intake when the initial appointment has been scheduled. The case manager must be contacted for consultation after the initial session and before a referral is made. There may be additional sessions available, however any sessions held without prior authorization may not be reimbursed.

As stated in Article III of the affiliate agreement, in order to receive payment for services, all clinical paperwork (attached) must be submitted within 30 days of completion of case. The information contained on these forms is used to evaluate quality improvement and statistical reporting, therefore it is imperative that all sections are filled out completely. Incomplete forms may result in delay of payment.

Please return completed paperwork to the case manager's attention at the following address or fax:

Feel free to contact us with any questions you may have. We can be reached at (800) 327 - 5071, Monday through Friday, 8:30 am - 5:00 pm CST. Thank you for your involvement in Workplace Solutions' EAP Affiliate Network.

Affiliate Progress Note
Case Opening Sheet
Case Closing Sheet
HIPAA - Notice of Privacy Practices ENGLISH
HIPAA - Notice of Privacy Practices SPANISH
Issues Assessed by Counselor List
Issues Presented by Client List
Release of Information (ROI) Client Form
Release of Information (ROI) Supervisor Form
Statement of Understanding ENGLISH
Statement of Understanding SPANISH

Click on About Us for more information about the services Workplace Solutions provides.  Contact Us to inquire further about becoming a valued member of our affiliate network.