The Benefit Funds will continue to cover telehealth services for your 1199SEIU patients. This includes visits via phone, video and other virtual means for all eligible medical and mental health services, including COVID-19-related services.

Effective October 15, 2021, the Benefit Funds no longer covers telehealth services provided by an urgent care center and will deny any claims with telehealth procedure codes or modifiers where the place of service is 20.

During the Public Health Emergency, the Benefit Funds covered all codes with a telehealth modifier of 95 or GT, or place of service code 02. Effective May 12, 2023, coverage determination will be made based on the Benefit Funds’ telehealth policy.

The cyberattack on Change Healthcare earlier this year disrupted the Benefit Funds’ electronic claims and payment processes. We appreciate your continued patience as we work to implement alternative solutions. We have partnered with Zelis and Inovalon to resume electronic claims and payment services, and we encourage you to use these two resources to ensure faster claims adjudications and payments.

The Benefit Funds have partnered with Inovalon to manage provider electronic claims submission, resulting in faster claims payment and account receivable reconciliation. The Benefit Funds’ payer number is 13162. Please call Inovalon at (800) 548-2890 or complete and submit an intake form and an Inovalon provider representative will contact you.

The Benefit Funds are partnering with Zelis to resume electronic payment processes in the near future. You can register now for electronic funds transfers and electronic remittance advice services through Zelis at no cost to you. Electronic payments from the Benefit Funds will begin after you complete the enrollment and setup process. To enroll, please visit the ePayment Center portal. If you have any questions, call Zelis at (833) 306-0337 or email help@epayment.center.

The Benefit Funds’ Healthy Living Resource Center provides 1199SEIU members with information to help them maintain a healthy lifestyle and improve their health outcomes. Located on the Benefit Funds’ website, the Healthy Living Resource Center has dedicated sections focusing on doctor-patient relationships, cardiac health, fitness, nutrition and emotional wellness. The site includes expert-sourced overviews; easy-to-follow tips and attainable goals; video presentations by participating healthcare providers; interactive exercises, such as nutrition quizzes and a BMI calculator; information on Benefit Funds benefits, programs and services; details about partnerships with employer institutions to promote primary- and preventive-care services; and links to external resources.

• Effective July 1, CVS Caremark is the Benefit Funds’ pharmacy benefit manager. Please review the CVS Caremark Preferred Drug List – Standard Control for Clients with Advanced Control Specialty Formulary for 1199SEIU Funds in searchable and print-friendly PDF formats, including the clinically appropriate preferred brand-name medicines, or call (833) 250-3273. We encourage you to prescribe medications to your 1199SEIU patients from this list to avoid having members incur out-of-pocket costs, to seek prior authorization when required and to comply with the medical exception process as needed.
• Keep your information up to date, including your payment and billing address. Please review the information we have on record for you and submit any changes using the Provider Demographic Information Change Request Form, along with a Form W-9. You can easily access the form and instructions from the Benefit Funds’ online provider directory by finding your listing in the directory, selecting “Report an Issue” and indicating your role as provider. While in the online directory, add your photo to your directory profile by selecting “Upload Provider Photo.” If you are outside New York City and are an Aetna provider, please ensure that Aetna has your updated information on file.
• Enroll in the NaviNet Provider portal to verify 1199SEIU patient eligibility, benefits, claims status and payment details.