1199SEIU Funds

Blog

  • Provider Notice/FAQ: COVID-19 During PHE

    In response to the COVID-19 pandemic, the Benefit Funds have temporarily changed certain policies to help ensure your 1199SEIU patients have access to medical services during the federal COVID-19 Public Health Emergency (PHE).

    Be sure to check the Funds website for changes and updates on temporary policy changes enacted by the Funds in response to the PHE. You may also call our Provider Relations Call Center at (646) 473-7160 to speak to a representative. Below are frequently asked questions (FAQ) to assist you in understanding coverage rules and policy changes that are in effect.

    1. Do you cover COVID-19 testing? (As of 09/29/21)

    Yes, the Funds cover diagnostic testing for the coronavirus, as well as antibody testing when ordered by a doctor. However, the Funds will not cover employment-related tests, antibody tests when there was a previously confirmed COVID-19 diagnosis, or antibody tests performed on the same date of service as a COVID-19 test and all antibody tests starting November 1, 2021. Based on CMS coding guidelines, providers should use the following codes when billing for COVID-19 testing:

    Lab Codes Code Description Billable Provider Type
    U0001 For the laboratory test developed by the CDC CDC Lab and Urgent Care Only
    U0002 For FDA-approved laboratory tests developed by entities other than the CDC using any technique Lab, Provider’s Office, Urgent Care, Facility
    U0003 For high-production technologies COVID-19 lab tests using any technique Lab and Urgent Care Only
    U0004 For high-production technologies COVID-19 lab tests using the probe technique Lab and Urgent Care Only
    C9803 For hospital outpatient COVID-19 specimen collection Hospital Outpatient Only
    86328 For laboratory antibody tests using the multi-step technique Lab, Facility, Provider’s Office, Urgent Care
    86769 For laboratory antibody tests using the single-step technique Lab, Facility, Provider’s Office, Urgent Care
    87635 Infectious agent detection by nucleic acid (DNA or RNA) severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique Lab, Facility, Provider’s Office, Urgent Care
    87426 Infectious agent antigen diagnostic test for the lab Lab, Facility Only
    87811 Infectious agent antigen diagnostic test with direct visual observation Lab, Provider’s Office, Urgent Care, Facility

    2. Are you waiving member cost sharing during this time? (As of 09/29/21)

    Yes, effective March 18, 2020, until the end of the PHE, we are waiving the following co-pays for COVID-19 related visits and diagnostic services:

    • For Home Care Benefit Fund members: $5/$10 co-pays for office visits (PCPs/Specialists); $25 inpatient co-pay
    • For Greater New York Benefit Fund members: $75 ER co-pay

    In addition, there is no co-pay for telehealth services.

    3. Are you covering telehealth services through the 1199SEIU provider network? (As of 09/29/21)

    Yes. Effective March 18, 2020, until the end of the PHE, we are covering telehealth services for your 1199SEIU patients in an effort to help limit contact during the COVID-19 crisis. We are covering consults via phone, video and other virtual means for all eligible medical and mental health services, including COVID-19-related services, except for telehealth services provided by an urgent care center. Effective October 15, 2021, the Benefit Funds will no longer cover 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.

    4. Are the operations of the Benefit Funds affected by the COVID-19 mandated protocols?

    The Funds’ physical offices, including our 498 Seventh Avenue at West 37th Street location, are open, and we continue to provide services for Funds members. We encourage providers to use our self-service options. To check 1199SEIU patient eligibility, benefit and claim status information, please visit our provider portal at www.NaviNet.net, or call (888) 819-1199 to be connected to our 24-hour automated claims and eligibility system. You can also email us at Providers@1199Funds.org. Please visit the Funds website’s “For Providers” page for important updates.

    5. Have your claims processing operations been impacted by the COVID-19 crisis?

    We are able to process all claims; however, electronic claims require minimal intervention and are likely to be processed more quickly. We encourage all providers to submit claims electronically and enroll in our Electronic Funds Transfer (EFT) Payment Program administered by Change Healthcare. Please visit our Claims page for details.

    6. How are your prior authorization and other review policies affected by the COVID-19 crisis?

    See information below for inpatient, outpatient and all other services.

    Inpatient services

    Effective March 24, 2020, to June 17, 2020, we temporarily suspended our prior authorization, continued-stay review and retrospective review requirements for inpatient admissions performed at a hospital. Prior authorization and continued-stay review requirements resumed on June 18, 2020. From March 24 to June 17, facilities were required to notify the Funds’ designated utilization management reviewer within 48 hours of all admissions and discharge planning by calling CareAllies at (800) 227-9360. Please note that all services provided during this period will be subject to retrospective review once normal operations have resumed, and final payment will be based on member eligibility at the time of service. Prior authorization, continued-stay review and retrospective review are suspended for the following services provided in the tri-state area (NY, NJ and CT). Prior authorization and continued-stay review requirements resumed on June 18, 2020.

    • All inpatient admissions, including behavioral health (for NY, NJ and CT hospitals only)
    • *Acute physical rehabilitation
    • Hospice (Inpatient)

    *Benefits are not provided by the Funds for care in a sub-acute nursing home or skilled nursing facility.

    Exceptions: Benefits are not provided by the Funds for care in a sub-acute nursing home or skilled nursing facility.

    • Long-term acute care (LTAC)
    • Experimental services

    Note: Inpatient Claims Prepayment Review Programs have been reinstated through MedReview, effective June 18, 2020. Facilities may contact MedReview via phone at (212) 897-6000 (main number) or (212) 897-6096. You can submit medical records securely via fax at (212) 897-6010 or via email at Portal@Medreview.us.

    Outpatient services

    Effective March 24, 2020, to June 17, 2020, we temporarily suspended our prior authorization requirements for outpatient ambulatory surgeries performed at a hospital. Prior authorization requirements resumed on June 18, 2020. Please note that all services provided during this period will be subject to retrospective review once normal operations have resumed, and final payment will be based on member eligibility at the time of service.

    Other outpatient services, including ambulatory surgical procedures performed at a freestanding Article 28 ambulatory surgical centers, are still subject to prior authorization. The prior authorization time frame for approved services will temporarily be extended to 180 days through September 30, 2020.

    Exceptions: Please continue to contact the Funds’ Care Management Programs at (646) 473-7446 for prior authorization of:

    • Experimental services

    All other services

    • Ambulance Service (non-emergent)
    • Cardiac/Pulmonary Rehabilitation
    • DME
    • Bone Growth Stimulator
    • Continuous Glucose Monitoring (CGM)
    • Hospital beds
    • INR Machine
    • Insulin pumps
    • Negative Pressure/ Wound Therapy (Input)
    • Oral Appliances
    • Oxygen / BiPap
    • Pneumatic Compression Devices
    • Prosthetic Devices (all)
    • Speech Devices
    • Transcutaneous electrical nerve stimulators (TENS)
    • Ventricular (VAD) Assist Devices
    • Wearable Defibrillators
    • Wheelchairs
    • Full and Split Night Sleep Studies (OSA Testing)
    • Homecare requests including
    • Enteral feeding
    • Intermittent skilled nursing services
    • Negative Pressure Wound Therapy (NPWT)
    • Physical/Occupational/Speech Therapy
    • Private duty nursing (120 hours per calendar year)
    • Hyperbaric Oxygen Therapy (HBOT)
    • Intensive Outpatient Program (IOP)
    • Lymphedema Therapy
    • Nutritional Services
    • Partial Hospitalization Program (PHP)
    • Prosthetic Devices
    • Requests for Outpatient Allergy visit beyond 20 per calendar
    • Request for Outpatient Physical/Occupational/ Speech therapy beyond 25 visits per discipline per calendar year

    Exceptions: Please continue to contact the Funds’ Care Management Program at (646) 473-7446 for prior authorization of:

    • Air Ambulance
    • Experimental services

    Please continue to contact the Funds’ Wellness Member Assistance Program at (646) 473-6900 for prior authorization for:

    • Transcranial Magnetic Stimulation (TMS)

    Inpatient, home care and non-emergency ambulance prior authorization temporarily suspended from December 23, 2020, to February 21, 2021.

    Inpatient UM Prior Authorization was temporarily suspended from December 23, 2020, to February 21, 2021, for medical, behavioral health, hospice and acute rehabilitation for New York only pursuant to DFS directives. No extensions for outpatient and elective admission authorizations were put in place. The standard 90-day authorization remained in effect. In addition, during this same period, authorization for home care services and non-emergency ambulance was suspended.

    7. Are there temporary changes to other medical management programs?

    Effective immediately, eviCore will extend existing authorizations on file for the following programs for members who were previously approved for an additional three (3) months if the extended authorization period does not exceed clinical practice guidelines. All existing authorizations on file expiring March 1, 2020, to May 31, 2020, will be extended through June 30, 2020. Time frames for approved services will temporarily be extended to 180 days through September 30, 2020.

    • Medical Oncology Program
    • Laboratory Management Program for Certain Outpatient Molecular and Genomic procedures
    • Radiology Review program for elective outpatient MRA/MRI, CT/CTA and PET imaging studies, as well as nuclear cardiology services
    • Radiation Therapy Management Program

    All new requests still require prior authorization. To initiate a new authorization or to verify an existing authorization period, please log on to www.eviCore.com or contact eviCore at (888) 910-1199.

    Medical Benefit Management (MBM) Program drug authorizations on file for members currently receiving drug treatment will be extended by CareContinuum for an additional three (3) months if the authorization period for the drug does not exceed clinical practice guidelines. For example, MBM drug authorizations expiring March 1, 2020, through May 31, 2020, will be extended through June 30, 2020. Time frames for approved services will temporarily be extended to 180 days through September 30, 2020.

    Prior authorization is required for all new drug therapy cases. To initiate a new authorization or to verify an authorization period on an existing drug therapy, please log on to www.express-path.com or contact CareContinuum at (877) 273-2122.

  • Takisha Jenkins: Member Profile

    Takisha Jenkins: Member Profile

    Takisha Jenkins

    Takisha Jenkins credits her benefits with helping her get healthy and maintain her well-being.

    Takisha Jenkins, a Medical Office Assistant at Cohen Children’s Medical Center – Northwell Health, and an 1199SEIU member for 17 years, has always been committed to staying healthy—and she relies on her Fund benefits to help her do so. In 2016, after suffering from an upset stomach, nausea and fatigue, she was diagnosed with small intestinal bacterial overgrowth (SIBO), a serious condition that can cause abdominal pain, digestive problems and even malnutrition. Her gastroenterologist prescribed a two-week course of antibiotics that, without her Benefit Fund prescription drug benefit, could have cost as much as $2,000. “I was relieved that I didn’t have to pay anything,” said Takisha. “And they delivered my medication free of charge to my home!”

    I have relatives who are lively and active in their 60s and 70s. I hope if I follow all of the advice I’m getting, I can be like that too.

    Takisha Jenkins

    Medical Office Assistant

    Cohen Children’s Medical Center – Northwell Health

    Having lost her mother and her grandmother to cancer, Takisha knows how important preventive screenings can be, so she goes for regular checkups without fail. She also attends the Fund’s quarterly wellness workshops, as well as a Fund-sponsored annual health fair at work. Taking what she’s learned at these events, Takisha stays as active as possible. She’s created a home gym, where she practices yoga, works out with a punching bag, does strength training and uses an elliptical machine. Her exercise routine even helps keep her mild asthma in check, so she doesn’t need to rely on inhalers or other medications.

    After recovering from her illness, Takisha also took her doctor’s advice and changed her diet by reducing her intake of sugar, bread and coffee, drinking more tea, and steaming vegetables like broccoli and cauliflower. She has been symptom- and pain-free ever since—and after losing 20 pounds, she is now at what she feels is a more comfortable weight. Now that her medical conditions are under control and she’s following a healthy lifestyle, Takisha continues to get wellness inspiration from the Benefit Fund, such as the Protecting Our Health calendars she has on display in her home. She also looks forward to reading each issue of For Your Benefit. “I get motivated by the stories of people like me, who’ve changed their lifestyles to eat healthier and exercise more,” she explained. “I have relatives who are lively and active in their 60s and 70s. I hope if I follow all of the advice I’m getting, I can be like that too.”

    For Your Benefit Magazine

    Current

    English | Español

    Previous

    English | Español

    Archive

  • We Are Covering Telehealth Services for Your 1199SEIU Patients

    We Are Covering Telehealth Services for Your 1199SEIU Patients

    Effective March 18, 2020, we are covering telehealth services for your 1199SEIU patients in an effort to help everyone limit contact with others during the COVID-19 crisis. We will cover consults via phone, video and other virtual means for all eligible medical and mental health services, including COVID-19 related services.

    As always, we thank you for your dedicated service to our members, especially in this time of crisis.

    More Provider Connections

  • Talk to a Therapist Through Teladoc

    Talk to a Therapist Through Teladoc

    Talk to a Therapist Through Teladoc

    Now you can connect with a doctor for behavioral and mental health issues through your Teladoc benefit. If you’re struggling with stress, anxiety, depression, issues related to addiction or another behavioral or mental health diagnosis, call or log on to Teladoc to speak with a licensed counselor, therapist, psychologist or psychiatrist from the privacy and convenience of your home. This benefit is only for eligible adults. Children in need of behavioral health services should still be referred to a specialist by your primary care doctor.

    Talk to a Doctor Now

  • COVID-19: Important Information about Your Teladoc Benefit

    COVID-19: Important Information about Your Teladoc Benefit

    COVID-19: Important Information about Your Teladoc Benefit

    Visit Teladoc
  • Dr. Dunn Delivers a Special Message to Our Members Working on the Frontlines of COVID-19

    Dr. Dunn Delivers a Special Message to Our Members Working on the Frontlines of COVID-19

    Dr. Dunn delivers a special message to our members working on the frontlines of COVID-19.

    Visit Teladoc

    About Dr. Dunn

    Dr. Dunn oversees the 1199SEIU Benefit Funds’ clinical, care management and analytics functions, and is responsible for pursuing health and wellness initiatives and value-based strategies.
    Read bio »

  • Oliveen Cowans-Mitchell: Member Profile

    Oliveen Cowans-Mitchell: Member Profile

    Oliveen Cowans-Mitchell

    Faced with an increased risk of diabetes, Oliveen Cowans-Mitchell got her health back on track with the help of her Benefit Fund.

    Every morning, Oliveen Cowans-Mitchell, a Certified Nursing Assistant at the Hebrew Home at Riverdale, begins her day with a smoothie packed with leafy greens and seasonal fruit. But that wasn’t always the case. Oliveen had always enjoyed making home-cooked meals, often rich dishes from her native Jamaica, while her busy work schedule had led her to rely on snacks and quick and convenient meals heavy in starches like potatoes and rice. After a routine checkup with her doctor in 2018 revealed she was pre-diabetic, Oliveen used her Benefit Fund coverage to take control of her health.

    Oliveen began regularly attending the Benefit Fund’s wellness workshops for healthy-eating tips, and she was excited to learn that she could receive additional help through pre-diabetes counseling. When she enrolled, a counselor helped her create a personalized diet and exercise plan to keep her blood sugar levels in check. Oliveen learned how to make some simple changes that made her meals healthier without sacrificing flavor
    or taking too much time to prepare..

    I’ve loved learning more about food and how to read nutrition labels. There is a lot of hidden sugar!

    Oliveen Cowans-Mitchell

    Certified Nursing Assistant

    Hebrew Home at Riverdale

    “I’ve loved learning more about food and how to read nutrition labels,” she said. “There is a lot of hidden sugar!” Oliveen now follows a diet low in carbohydrates with no added sugar, uses oil-free cooking methods to prepare favorites like baked salmon and steamed vegetables, and pays attention to portion sizes.

    She also exercises three to five times a week at a gym near her home in the Bronx, where she focuses on cardio workouts on the StairMaster or the stationary bike. Weight training has become a favorite part of Oliveen’s regimen, which she says makes her feel “strong and toned.” Her healthy lifestyle has even helped her lose 23 pounds and drop several sizes over the past year.

    With a family history of diabetes, Oliveen knows the importance of continuing to manage her risk, and she tries to encourage her sister to be more proactive with her own health. She has also shared her healthier outlook with colleagues, who say they’re motivated to make changes after seeing her success. Oliveen is confident she will reach her weight-loss goals and get her blood sugar levels within the healthy range: “I’m never looking back!”

    For Your Benefit Magazine

    Current

    English | Español

    Previous

    English | Español

    Archive

  • When Your Doctor Is Not Available, There’s Teladoc

    When Your Doctor Is Not Available, There’s Teladoc

    When you can’t reach your doctor, Teladoc provides you with the care you need. Dr. Van Dunn discusses the advantages of using Teladoc and the simple steps you can take to access your benefit.

    Talk to a Doctor Now

  • Child Care Corporation Celebrates Youth Mentoring Program Participants

    Child Care Corporation Celebrates Youth Mentoring Program Participants

    Child Care Corporation Celebrates Youth Mentoring Program Participants

    The 1199SEIU Employer/Child Care Corporation (CCC) recognized 231 student participants of the Youth Mentoring Program (YMP) at a ceremony held at the New York Academy of Medicine on August 15. Every year, the YMP offers teens ages 15 to 17 invaluable opportunities to explore careers in the healthcare industry by providing them with real-world work experience during their summer vacation. This year, 22 sites in New York City participated in the program. Each student was placed at a worksite, which was his or her parent’s place of employment, and for 24 hours a week, the student provided assistance with clerical tasks; some students were even able to assist healthcare professionals such as pharmacy technicians. The YMP also provided students with onsite mentoring and opportunities to attend development seminars to help enhance their resumes and professional portfolios.

    This year’s ceremony opened with CCC’s Vice President Rossmery Dais welcoming students, their families and guests, before former and current YMP participants and site supervisors reflected on the impact of the program. In his keynote address, former site supervisor Daitwan Davis highlighted the YMP’s success in encouraging the development of positive skill sets and teaching youth the importance of meeting expectations in a professional environment. YMP participant Katherine Wu, who worked in the wound care department at Maimonides Medical Center, echoed Daitwan’s sentiments. She entered the YMP hoping to develop a strong work ethic and a greater understanding of the many occupations in the healthcare industry. She credited the program with giving her “valuable life experiences, more self-assurance and independence.”

  • Student Spotlight: Kimberly Amazan

    Student Spotlight: Kimberly Amazan

    Student Spotlight: Kimberly Amazan

    Kimberly Amazan has participated in 1199SEIU Child Care Funds (CCF) youth programs for most of her life, with memorable experiences in the Summer Day Camp and Holiday Sleep-Away programs. But her two years in the WorkForce 2000 Program have been the most impactful by helping her to explore areas of study that interested her, to gain work experience and to bolster her desire for a career in nursing. “I wasn’t sure what I wanted to study,” Kimberly said, “but the program helped me zone in on nursing.”

    Now a junior at the New York Institute of Technology, Kimberly continues to tap into her lifelong interest in science as a nursing major, taking courses like pharmacology. “When you’re a kid, you just take medicine because your parents or a doctor tells you to,” she said. “Now I get to learn how everything works, and that’s exciting!”

    With a busy schedule and a full course load, Kimberly is grateful for the support that the Joseph Tauber Scholarship Program’s Next Generation RN award affords her. With the “extra boost” it has given her, she has had more time to focus on her schoolwork without having to worry about her ability to purchase books and other necessities. Following graduation, Kimberly plans to continue pursuing her nursing career by taking the certification exam, and hopes to work in the New York City metropolitan area.

    Kimberly’s mother, Enone Amazan, a Registered Nurse at the Schulman and Schachne Institute for Nursing and Rehabilitation and an 18-year 1199SEIU member, is thankful for all of the CCF benefits and programs her four children have taken advantage of to help them reach their academic and professional goals. “The Child Care Fund invests in children’s success from an early age,” said Enone. “These programs have encouraged each of my children to value learning and have helped them become the strong-minded individuals they are today.”