Enhancements to eviCore Streamline Prior Authorization Process
Funds Launch Updated Provider Directory
The Benefit Funds have introduced a new online provider directory platform with an enhanced user interface. We encourage you to review your office information and report any discrepancies by completing the Provider Demographic Information Change Request Form located on the Forms and Resources for Providers page.
Important Reminders
- To help ensure that your 1199SEIU patients receive quality care, every three years the Benefit Funds recredential all applicable healthcare providers who participate in our provider network. Please respond to any requests for recredentialing and follow all instructions to avoid disruption in your network participation status.
- Our Provider Relations Department is offering virtual education visits to review policies and/or answer questions. Please contact your Provider Relations representative to schedule a session.
- The Benefit Funds’ Preferred Drug List (PDL) and the Medical Plan PDL administered by Care Continuum are updated periodically. Please check the PDL page on the Funds’ website for the latest information.
More Provider Connections
Ensure Faster Claims Processing by Using Correct Billing Codes
The National Correct Coding Initiative (NCCI), which promotes national correct coding methodologies and controls improper coding and incorrect payments for medical services, includes three types of edits: NCCI Procedure-to-Procedure Edits prevent inappropriate payment...
ClaimsXTen Select Is Now Lyric
The Benefit Funds’ claims auditing software ClaimsXten Select is now Lyric. Only the name—not the software—has changed. Lyric will continue to assess the appropriateness of professional and outpatient hospital claims against clinically based coding rules and edits,...
The Benefit Funds Credentialing Committee Seeks Board-certified Physicians
The Benefit Funds invite all board-certified participating providers with exemplary credentials and leadership qualities to join the 1199SEIU Benefit Funds Credentialing Committee. As a committee member, you would help ensure that the Benefit Funds maintain a...
The Benefit Funds Are Recredentialing Our Provider Network
The Benefit Funds are recredentialing our provider network and need your help to ensure that members have access to quality in-network healthcare providers. Please update your Council for Affordable Quality Healthcare (CAQH) application and your attestation form. You...
Important Alerts and Reminders
Aetna Choice POS II has been the wraparound network supplementing the Benefit Funds’ directly contracted network for coverage outside New York City since March 2, 2023. Aetna Choice POS II New York City provider locations are considered nonparticipating. Members must...