Resources & Forms
* These resources and forms are not required if equivalent documentation is completed by clients. These resources are meant as a resource if a facility or provider does not have an equivalent. MINES does not require copies of this documentation.
WPR Network – Click here to read our WPR handbook to learn more about the WPR process and expectations. If you would like to join this subnetwork, please submit your application here.
Acknowledgment of Receipt of Notice of Privacy Practices
This form must be presented to each client on their first visit.
MINES & Associates EAP Program
Program information is to be read & signed by all clients.
Client rights statement required by law for all clients to read and sign.
For clinical exception cases when external referrals are not viable – must be executed in conjunction with Mines case manager.
Authorization for Release of Health Information
To be completed when confidential health information needs to be released. Please note, a release of information is not required for providers to talk to MINES about a MINES client. This form is only for persons trying to access information about another client (i.e. parent for an adult child, spouse for spouse) or if MINES is requested to talk to an adult about an adult client on the provider’s behalf. This form may also be used as the basis to create an ROI form for yourself. To submit for the purpose of having MINES talk to someone, please send this completed form back by email.
EAP Evaluation/Treatment Plan
Sign in to the Provider Portal to request additional authorizations.
Additional Information
Frequently Asked Questions by EAP Affiliates
Providers (Psychiatrists, Psychologists, Social Workers, Licensed Professional Counselors, Licensed Marriage & Family Therapists, Nurse Practitioners, etc.) providing services through the insurance side of members’ benefit plans.
IMPORTANT INFORMATION ABOUT CLAIMS:
Please submit all insurance-related billing to Mines at:
MINES and Associates Claims
P.O. Box 270669
Littleton, CO 80127
Other contact methods:
Toll-free: 800-873-7138 x4051
Claims line: 303-832-1068 x4051
Fax: 303-832-9701
To check benefits, eligibility, or exclusions, please check the client’s insurance card.
Should we request you to review the appeal from a facility around the level of care, please review this handbook around our standards for these reviews.
Psychological Assessment Request Form
Use this form to request psychological assessment testing for a MINES’ client.
Authorization for Release of Health Information
To be completed when confidential health information needs to be released. Please note, a release of information is not required for providers to talk to MINES about a MINES client. This form is only for persons trying to access information about another client (i.e. parent for an adult child, spouse for spouse) or if MINES is requested to talk to an adult about an adult client on the provider’s behalf. This form may also be used as the basis to create an ROI form for yourself. To submit for the purpose of having MINES talk to someone, please send this completed form back by email.
Medication Evaluation/Management and PPO/Managed Care Evaluation Treatment Plans
No treatment plan is needed for Outpatient Managed Care clients. If this is for EAP, please fill out the treatment plan on the Provider Portal. If this is in regard to psych testing or hospitalization (IOP or higher) services, please contact MINES at 1-800-873-7138 to speak with a case manager.
Additional Information
Review required procedures for those providing services to insure reimbursement.
Summary of Responsibilities for Managed Care Clients
Outlines responsibilities of providers, clients, and insurance company
The following are resources for various MINES’ services outside the standard EAP and PPO services.
CISS (Critical Incident Support Services) Handbook
This handbook contains the essential information around providing CISS services through MINES.
The handbook has essential information relevant to those conducting trainings for MINES’ clients.
This billing form is to be used for OD, CISS, and other services. Not to be used for EAP or PPO billing.
We want to provide you with some great resources so you can feel prepared to handle the various life situations that you come across while treating our clients. Please feel free to check out any of the items below from our community partners.
Webinars
- For clinical webinars from our partners at Recovery Village please click here.
- For CEU and clinical webinars from our partners at Harmony Foundation please click here.
- For CEU and clinical webinars from our partners at Sierra Tuscon please click here.
Other Resources
- Colorado Drug and Alcohol Resources from our Partners at AspenRidge Recovery can be found here.
- The article and discussion about suicidal teens can be found here.
- Resources from Samsha can be found here.
- Clinical resources, articles, and webinars from PsychU can be found here.
*These resources are not from MINES or MINES Sponsored but may have some good resources and information that you may find helpful in your practice.*
Information and contact
- MINES is looking for feedback from our Providers. Click here to take the survey
- To view quick reference videos for many processes as a MINES provider, check out our Provider 101 series for helpful tips.
- Applied but never accessed our Provider Portal? Having trouble logging in above? Send us an email and we’ll send you your account information!
Privacy Practices in compliance with the Health Insurance Portability and Accountability Act [HIPAA] must be made available to each client.
