EAP Affiliate Information:
This area is for those providing EAP/MAP services and includes the following forms: EAP Billing Form, EAP Evaluation/Treatment Plan, Client Information Form, Mines & Associates EAP/MAP Program Information, Freedom of Choice Affidavit, Notification of Privacy Practice, Authorization for Release of Health Information, Summary of Responsibilities for Managed Care Clients, Your Rights As A Client.
Managed Care Provider Information:
PLEASE NOTE: Authorizations will not be backdated by more than 30 days
This area is for those providing services through the client's insurance (psychotherapy and/or medication management) for those contracts where MINES is the Managed Care entity and includes the following forms: Medication/Evaluation/Management Treatment Report, PPO/Managed Care Evaluation/Treatment Plan, Authorization for Release of Health Information, Provider Procedures, Summary of Responsibilities for Managed Care Clients.
SBIRT Wellness Coaches
PLEASE NOTE: SBIRT Colorado Grant concluded on August 31, 2016
Screening, Brief Intervention & Referral to Treatment II (SBIRT II) Information:
This area is for those providing "Wellness Coaching" services through the "Colorado Screening, Brief Intervention & Referral to Treatment (SBIRT)" Grant and includes the following: Procedure Summary for SBIRT Wellness Coaches, Recorded Training for SBIRT Wellness Coaches, What is SBIRT Wellness Coaching, Mines Disclosure Forms, SBIRT Wellness Coaching Tool, SBIRT Wellness Coaching - Coach's Packet, SBIRT Wellness Coach Billing Form, SBIRT Billing Submission Process.