Affiliate Provider Process

Before IMPACT Workplace Services refers a client to any affiliated provider, we call to confirm that new clients are welcome. It is the client's responsibility to contact providers to schedule an appointment.

At the time of the referral, you will receive general information about the client's situation; their employer; the type of referral [voluntary or company mandated]; and the number of approved counseling sessions.

  • If your counselor meets with the client and believes that he/she requires more sessions, the counselor must contact us before proceeding.
  • The referral is valid for 120 days. Any counseling services required beyond 120 days require a new referral and authorization.

All correspondence with the client's employer must be channeled through IMPACT Workplace Services. DO NOT contact the employer directly or ask the client to deliver information, letters or other paperwork to his/her employer on your behalf.

After The Initial Counseling Session

Complete the following forms and fax to IMPACT Workplace Services at (414)771-4808.

Payment For Services

Please submit an invoice within 30 days of the date of service using Form 5 - Billing Statement. A copy of your current Certificate of Insurance must be on file with us or payment may be delayed. You will receive payment for services based on the terms of agreement in the affiliate contract.