Blog

  • CCF and CCC Respond to COVID-19 Emergency Child-care Needs

    CCF and CCC Respond to COVID-19 Emergency Child-care Needs

    CCF and CCC Respond to COVID-19 Emergency Child-care Needs

    Even as all in-person activities were canceled last spring due to COVID-19, the Child Care Funds (CCF) and Child Care Corporation (CCC) continued to deliver remote programming and essential services. When financial and child-care needs grew during the pandemic, we were able to provide emergency child-care financial relief to both members and non-members.

    In partnership with our donors—the JPB Foundation, Segal Family Foundation, Element Capital, PAC, Robin Hood Foundation and Mastercard Impact Fund—the CCF and CCC assisted more than 7,500 members and other healthcare workers with emergency child-care financial relief in the amount of $3.5 million.

    The Child Care Resource and Referral Services (CCR&R) team also helped members without child care find alternative providers throughout the five boroughs and Nassau, Suffolk and Westchester counties. Within the first seven months of the COVID-19 pandemic, 1,300 1199SEIU members received referrals, affording them much-needed peace of mind and support as they worked on the frontlines. Many of our members were adversely affected by program cancellations and summer day camp closures, and our staff provided 4,000 stipends in lieu of approved benefits to support their child-care needs, totaling nearly $7 million.

    To measure the effectiveness of the Funds’ COVID-19 response, our Assessment and Compliance Department administered a survey to more than 24,000 healthcare workers.

    Some of the significant findings include:
    73 percent of healthcare workers used the financial assistance to pay for babysitting and in-home care.
    70 percent indicated that the child-care emergency financial relief enabled them to maintain a consistent work schedule.
    65 percent said they remain uncomfortable sending their children to outside care and prefer informal child-care options.
    65 percent of healthcare workers’ children are participating in remote learning.

    In addition, we learned that many families are spending $250 a week or more on child care or are facing financial hardship caused by unpaid leave from work, caring for children forced to stay home due to program and school closures.

    At the start of the new year, the Funds had a waiting list of more than 1,000 healthcare workers in need of support. We anticipate the pandemic will continue to impact the child-care and financial needs of our essential workers, and we remain committed to providing support when and where it’s needed most.

  • Linda Askew: Member Profile

    Linda Askew: Member Profile

    Linda Askew

    Linda has always relied on her 1199SEIU Funds to help keep her and her family healthy—never more so than throughout the COVID-19 pandemic.

    More than two decades ago, Linda Askew made a life-changing career decision when she moved from the transportation industry to healthcare—and she hasn’t looked back. A Senior Clerk at Montefiore Medical Center in the Bronx, Linda knows she made the right move all those years ago.

    Of course, when the COVID-19 pandemic began, Linda’s job changed in ways she couldn’t have imagined. In addition to printing labels to draw blood and processing forms to refill patients’ medications, she began scheduling telehealth visits—and even found herself having to learn how to help patients install an app on their phone so they could access care from home. And throughout the pandemic, she didn’t miss a single day of work. “I look at patients like my family,” Linda said. “They’re here because something is wrong, so I’m here to help them, especially when things get rough.”

    My family is healthier because of the care we get. We are able to do it all with wonderful physicians, thanks to my benefits. They’re a blessing.

    Linda Askew

    Senior Clerk

    Montefiore Medical Center

    A mother of three and happily married to husband Tony for over 44 years, Linda has had to grapple with some health issues of her own. Years ago, she learned from her doctor that she had high blood pressure and was prediabetic. Her doctor prescribed medication for her condition—all covered by her Benefit Fund—and advised her to make some lifestyle changes. “I decided to take my condition seriously,” Linda said. Although she loved cooking with flavorful but high-sodium southernstyle seasonings and snacking on salted pumpkin seeds, she cut them from her diet. For exercise, she began walking 45 minutes home from work, which has also helped relieve stress—especially important during the pandemic. “I put on my headphones, turn on my gospel music for inspiration and just start walking,” she explained. “By the time I’m home, I feel calm and energized.”

    Over the years, Linda has made good use of all of her Funds benefits. She used her training benefits to go back to school to become a Patient Care Technician, and her child-care benefits allowed her youngest son, Quinton, to attend three years of summer camp, where he made friends he’s still in touch with 18 years later.

    Even though she’s eligible to retire, Linda is not ready to do so just yet. But she is planning to speak to a Pension Counselor to learn about her options for when the time is right, so she can spend quality time with her grandchildren. “My family is healthier because of the care we get,” she said. “We are able to do it all with wonderful physicians, thanks to my benefits. They’re a blessing.”

    For Your Benefit Magazine

  • “Get the Latest Vaccine Updates from Our Own Dr. Dunn”

    “Get the Latest Vaccine Updates from Our Own Dr. Dunn”

    Dr. Dunn answers your questions and updates you on what you need to know about the vaccines, including their safety and effectiveness and possible side effects. He also shares his personal experience after receiving his second dose of the vaccine last month.

  • Greater New York Pension Information Session Replay

    Greater New York Pension Information Session Replay

    Greater New York Pension Information Session Replay

    In this webinar, you will learn about the pension options available to you, how to apply for your pension and whether you are eligible to receive retiree health coverage through the Greater New York Benefit Fund.

  • Health Care Employees Pension Information Session Replay

    Health Care Employees Pension Information Session Replay

    Health Care Employees Pension Information Session Replay

    In this webinar, you will learn about the pension options available to you, how to apply for your pension and whether you are eligible to receive retiree health coverage through the National Benefit Fund.

  • Getting Ready for Retirement

    Getting Ready for Retirement

    Getting Ready for Retirement

    Getting ready for retirement involves more than money matters—moving on from working life also has emotional and social effects that can make the transition challenging. This webinar explores aspects of retirement you might not have considered, and how to best approach the changes and adjustments that come with this major life event.

  • Lyric’s ClaimsXten Solution Frequently Asked Questions (FAQs)

    Lyric’s ClaimsXten Solution Frequently Asked Questions (FAQs)

    What is Lyric’s ClaimsXten™ Solution, and why have the 1199SEIU Benefit Funds implemented this software?

    ClaimsXten Solution is a clinically based claims-editing software solution that advances claims-auditing capabilities and resolves limitations in the current ClaimCheck software. ClaimsXten Solution offers clinical coding logic and rules-based claims management with the capability of implementing customized Benefit Funds’ policies, as well as the ability to read historical claims data. The customization provides consistency in managing the complexities of benefit plans, provider contracts and reimbursement policies. ClaimsXten Solution will adjudicate claims in a manner that is more efficient and aligns with industry standards.

    Whom does this affect?
    Physicians, other healthcare professionals, outpatient hospitals, ambulatory surgical centers, and ancillary providers billing paper and electronic claims to the Benefit Funds will have their claims evaluated and processed according to the ClaimsXten Solution code-auditing software rules and clinical rationale
    How will this affect reimbursement?
    The implementation of ClaimsXten Solution editing will not impact the reimbursement rates outlined in provider contracts. However, edits may impact how a claim or claim line is processed. Most of the edits being implemented are already applied to current claims with the current ClaimCheck software, such as National Correct Coding Initiative (NCCI) and American Medical Association (AMA) Procedure Manual guidelines.
    What do NCCI policies and guidelines entail?
    The Centers for Medicare & Medicaid Services (CMS) developed the NCCI to promote national correct coding methodologies and to control improper coding and incorrect payments for medical services. The coding policies are based on coding conventions defined in the AMA’s Current Procedural Terminology (CPT) Manual, national and local Medicare policies and edits, coding guidelines developed by national societies, standard medical and surgical practice, and current coding practice. According to the NCCI Policy Manual, NCCI includes the following three types of edits:
    1. NCCI Procedure-to-Procedure Edits prevent inappropriate payment of services that should not be reported together. If a provider reports the two codes of an edit pair for the same member on the same date of service, the column one code is eligible for payment, but the column two code is denied, unless a clinically appropriate NCCI associated modifier is also reported.
    2. Medically Unlikely Edits (MUEs) prevent payment for an inappropriate number/quantity of the same service on a single day. An MUE for a Healthcare Common Procedure Coding System (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.
    3. Add-on Code Edits consist of a listing of HCPCS and CPT add-on codes with their respective primary codes. An add-on code is eligible for payment if, and only if, one of its primary codes is also eligible for payment.
    Will there be changes in how providers submit claims?
    No. Providers should bill in accordance with industry standard billing, which includes using current CMS National Uniform Claim Committee (NUCC) CMS Form 1500 or UB-04 CMS-1450 (UB-04) Form, or the electronic equivalent, whichever is appropriate, with applicable coding including, but not limited to, ICD-10 Current Procedural Terminology, CPT codes, HCPCS coding, appropriate modifier(s) and/or Revenue Code. Note: If the service or procedure is missing the appropriate modifier or was reported with the incorrect modifier, an edit will be applied.
    How will we be notified of new edits?
    When new edits are implemented, we will notify you through the Provider Connections electronic newsletter, the Benefit Funds website and/or the Provider Portal. ClaimsXten Solution will continue to be updated on a quarterly or as-needed basis, as new CPT/HCPCS and NCCI edits and other CMS data are issued.
    Will these edits read historical claims data?
    Yes. ClaimsXten Solution will continue to identify services that have been previously submitted in conjunction with the current claim being evaluated. This may result in historical claims adjustments or appropriate offset from the current claim.
    How can we identify claims/claim lines that have ClaimsXten Solution edits applied?
    These are identifiable by the explanation codes on your Explanation of Payment, as well as within NaviNet. A brief description of the edit rationale will be provided with the explanation code.
    What if I disagree with how the claim was processed?
    If you disagree with an applied edit, you will need to submit an inquiry within 180 days of the date of the initial claim denial or adverse benefit determination. Reconsideration inquiries must include an explanation of the reason for the reconsideration request and supporting documentation, such as medical records or industry reference sources (NCCI table, AMA CPT/HCPCs, CMS Medicare Learning Network, etc.). You may submit your reconsideration request in writing by using the Medical Claim Reconsideration Request form. You may mail, fax or email the form to:

    Mail: 1199SEIU Benefit Funds, Medical Claims Reconsideration, P.O. Box 717, New York, NY 10108-0717 Fax: (646) 473-7088 Email: MedicalRecon@1199Funds.org

    How can I determine if the codes I am submitting on a claim will be evaluated by ClaimsXten Solution during claim adjudication, and what will be the anticipated outcome?
    The edits within ClaimsXten Solution are composed of CPT/HCPCS with valid modifiers, CMS, AMA Coding Manual and Correct Coding Initiative coding and billing practices. In the interim, resources such as the NCCI tables available on the CMS website can be used to identify code pairs and the proper application of modifiers. For additional information regarding ClaimsXten Solution, email Providers@1199Funds.org. You should receive a response within 24 hours.
  • Benefit Funds to Upgrade Our Claims Auditing Software

    Benefit Funds to Upgrade Our Claims Auditing Software

    Effective March 1, the Benefit Funds will upgrade our claims-auditing platform, from ClaimCheck to ClaimsXten, to meet our needs for a more comprehensive and well-known solution that is used by many payers to adjudicate applicable claims according to prevailing guidelines. ClaimsXten will assess the appropriateness of professional and outpatient hospital claims information against clinically based coding rules and edits, resulting in accurate and quicker provider reimbursement.

    This upgrade to ClaimsXten will:

    • Improve the accuracy of the Benefit Funds’ reimbursement coding policies;
    • Provide enhanced technical functionality, thus reducing the need for manual reviews; and
    • Assist with maintaining a consistent payment policy in alignment with CMS and industry standard billing guidelines.

    You will continue to be responsible for billing with the most appropriate and valid CPT and/or HCPCS procedure codes, including applicable modifiers, for services that are consistent with the American Medical Association CPT manual and other similar publications. You will see edit reasons and explanations on your remittance notices when claims are not coded in accordance with the appropriate coding guidelines.

    ClaimsXten: Information and Frequently Asked Questions

    For more information, visit the Benefit Funds’ website in the coming weeks, contact your Provider Relations Representative or call our Provider Relations Call Center at (646) 473-7160.

    More Provider Connections

    Archive
  • Healthy Finances: Working Toward Retirement, Part 2

    Healthy Finances: Working Toward Retirement, Part 2

    Ryan C. Mack continues the retirement discussion on long-term goals and provides information about investments and definitions for financial terminology. This video helps you determine how much money you will need once you stop working and the best time to start collecting benefits.

    Healthy Finances

    • Banking Basics

      Wednesday, October 22, at 6:00 pm

      Banking Basics teaches you how to open accounts, make deposits and withdrawals, monitor fees, maintain balances, conduct transactions remotely safely, and more.

    • Understanding Your Paycheck

      Wednesday, November 19, at 6:00 pm

      In this webinar, you'll learn about payroll and tax deductions, social security, Medicare, FICA and more.

    • How Credit Works

      Wednesday, December 10, at 6:00 pm

      Utilizing credit, credit reporting, credit scores and credit impact. Understand credit and learn how lenders determine your credit worthiness and more in this webinar.

    Other Healthy Finances Courses

    Understanding Your Paycheck

    Saving Strategies Part One

    Next Live Video:
    Wednesday, March 1, 2023 at 6:00 pm

    Saving Strategies Part Two

    Next Live Video:
    Wednesday, March 15, 2023 at 6:00 pm

    Give Me Some Credit

    Next Live Video:
    Wednesday, March 29, 2023 at 6:00 pm

    Recovering from Financial Hardship: It’s Not Over!

    Next Live Video:
    Wednesday, April 12, 2023 at 6:00 pm

    Working Toward Retirement, Part One

    Next Live Video:
    Wednesday, April 26, 2023 at 6:00 pm

    Working Toward Retirement, Part Two

    Next Live Video:
    Wednesday, May 10, 2023 at 6:00 pm

    Growing Your Money

    Next Live Video:
    Wednesday, May 24, 2023 at 6:00 pm

  • Seasonal Herbs and Botanicals for Better Health

    Seasonal Herbs and Botanicals for Better Health

    Seasonal Herbs and Botanicals for Better Health

    Learn about the connection between what you eat and how you think and feel, as well as about foods that can feed both your body and mind—without emptying your wallet.