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Network Operations Forms

FEI Referral Packet

Referral Packet

*In order to process payment, claim forms must be completed and returned to FEI's claim department via fax: 414-359-6717. Claims must be submitted within 30 days of the authorization end date.
All sessions must be pre authorized by FEI Behavioral Health.

Joining FEI's Provider Network

If you would like to join our provider network or add clinicians to an existing FEI-approved clinic, please complete an EAP Affiliate Application and submit along with a copy of the clinicians license, liability insurance, resume and W9. Completed applications and supporting documents can be submitted via email or fax: 414-359-6519. If you have any questions, contact the Network Operations Department at (800) 782-1948 option 2.

*Please verify that all information is saved on forms before submitting.


Required Application Forms

Affiliate Application

Affiliate Agreement

Affiliate Manual

W9

*As a provider for FEI Behavioral Health, we ask that you review the Affiliate Manual. Please make it available to all FEI-approved clinicians and branch offices.


Specialist Applications

Substance Abuse Specialist

Trauma Specialist

Training Specialist

Military and Veteran Specialist

 

Information Update Forms

Affiliate Information Update

Affiliate Add Business Location