Confirmation Page

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The following information is what was submitted on the Espyr Clinician Invoice Form. We recommend that you save  this page for your records.

Entry ID: {entry_id}
Counselor: {Counselor:1}
Email Address: {Email Address:73}
Authorization Number: {Authorizaton Number:72}
Client DOB: {Client Date of Birth:71}
Attended EAP session? {Attended EAP session?:36}

Date Seen: {Date Seen 1:53}

Date Seen: {Date Seen 2:54}

Date Seen: {Date Seen 3:55}

Date Seen: {Date Seen 4:56}

Date Seen: {Date Seen 5:57}

Date Seen: {Date Seen 6:58}

Date Seen: {Date Seen 7:59}

Date Seen: {Date Seen 8:60}

Date Seen: {Date Seen 9:99}

Date Seen: {Date Seen 10:98}

Date Seen: {Date Seen 11:97}

Date Seen: {Date Seen 12:103}

Follow-up call made: {Follow up call made?:40}
Name of Person Submitting: {Your name (First):107.3} {Your name (Last):107.6}
Date Submitted: 07/17/2024

Billing Reminder

All invoices must be received within 30 days after the session date to be eligible for payment Clinicians may invoice after each session, or after any number of sessions; however, invoices must be submitted to Espyr no later than thirty (30) days after each session to be eligible for reimbursement. Espyr does not compensate clinicians for client no-shows or late cancellations, nor may the client be held financially liable for no-shows or unauthorized services (including, but not limited to cancellation fees and/or administrative fees). Espyr clients are not responsible for the cost of EAP sessions and are not to be invoiced. The EAP closed case form should be submitted with the final invoice.

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