Affiliate ProvidersThank you for your interest in becoming an Ascension WI EAP subcontract provider. We expand our network as our business expands, and currently provide EAP services across the United States and Canada. We require licensed counselors with experience in assessment, brief counseling and case management. Areas of higher need include counselors with experience in Alcohol and Substance Abuse assessment and treatment, Critical Incident Stress Services (Trauma Informed Counselors) and Workplace issues.
Become a Provider
Thank you for your interest in becoming a part of our provider network. Complete the application and mail it to Ascension WI EAP along with the required documentation. We will contact you upon receipt of your completed application. Submission of application does not ensure your acceptance into our provider network.
I am a Provider
Thank you for providing the best service possible to our EAP clients in your area. You may download any forms, complete them in a timely way, and mail them to Ascension WI EAP for appropriate reimbursement. All EAP services must be pre-authorized by an Ascension WI EAP counselor prior to your provision of service. All paperwork must be mailed to Ascension WI EAP within the same quarter of service.
- Affiliate Explanation of Authorization
- Affiliate Invoice
- Client Intake Form
- Freedom of Choice
- HIPPA Notice of Privacy Practices
- Release of Information – Blank
- Release of Information (EAP to Employer)
- Release of Information (Employer to EAP)
- Statement of Understanding