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WellSpan Employee Assistance Program

WellSpan Employee Assistance Program

Provider Forms & Information

Participating Provider Forms

Participating Provider Step-by-Step Procedures (explains referral WSEAP process) 

WSEAP Statement of Understanding form (this must be signed by every EAP patient)

Sample EAP HCFA 1500 Claim Form (please use this as a guide for all claims)

WSEAP Referral & Invoice Form (use only if provider cannot use HCFA 1500 form)

New Provider Application

Client Status Report (completed by therapist after any supervisor referral session)

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About the provider search

This search will provide you with WellSpan Medical Group and Northern Lancaster County (Ephrata) Medical Group primary care physicians and specialists. If we don’t have a WellSpan Medical Group physician to meet your criteria, the search will expand to include community physicians who partner with WellSpan Medical Group physicians through the WellSpan Provider Network or provide care to patients on the Medical Staffs of WellSpan’s Hospitals.

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