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 preferrs claims to be electronically submitted, emailed securely (wellspaneap@wellspan.org) or faxed. |
| Customer Service #: |
1-800-673-2514 |
| FAX: |
717-755-7190 claims only |
| Electronic Payor #: |
CB457 |
| Initial Visit Code: |
90791 |
| Subsequent Visit: |
90834 |
| Subsequent Visit: |
90837 |
Family/Couples
Code: |
90846 |
Family/Couples
Code: |
90847 |
If you have any questions, please call WellSpan EAP customer service at 1-800-673-2514.
