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Affiliate Providers

Affiliate Providers

Billing Information

We have the capability to accept claims electronically.  Our electronic payor number is CB457.  If you choose to send claims electronically, please use the below CPT-4 codes. To see a sample HCFA 1500 form or for a WellSpan EAP referral and invoice form please click below. 

Sample HCFA 1500 Claim Form 
WellSpan Referral and Invoice Form 

WellSpan EAP Billing Information
Claims Address: WellSpan EAP
P.O. Box 1827
York, PA 17405-1827
Customer Service #: 1-866-227-6527
FAX: 717-851-4493
Electronic Payor #: CB457
Initial Visit Code: 90791
Subsequent Visit: 90834
Subsequent Visit: 90837
Family/Couples
Code:
90846
Family/Couples
Code:
90847

We will continue to accept paper claims from your practice. 
The billing address for EAP claims is: WellSpan EAP, PO Box 1827, York, PA 17405-1827.

If you have any questions, please call WellSpan EAP customer service at 1-866-227-6527.

 

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