Updates to Claims Auditing Software
In the coming months, the 1199SEIU Benefit Funds’ ClaimsXten Select Claims auditing software system will be updated to include Medically Unlikely Edits (MUEs), which prevent payment for an inappropriate number/quantity of the same service on a single day. An MUE for an HCPCS/CPT code is the maximum number of units of service under most circumstances reportable by the same provider for the same member on the same date of service. For more information, visit our Providers’ page, where we will be posting more news about the software update; contact your Provider Relations representative; or call our Provider Relations Call Center at (646) 473-7160.
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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...