While the Funds’ offices are currently closed during the COVID-19 coronavirus outbreak, we are providing essential services with limited staffing. You can request a form, change your address and more by visiting My Account. If you need assistance with your benefits, please contact your Outreach Coordinator and he or she will get back to you as soon as possible. Your Coordinator’s contact information is available on the bulletin board at your worksite and in the Resources section.

    Please note that while we are monitoring our main Member Services line at (646) 473-9200, it should be used for urgent matters only and you will experience long wait times to speak to a Service Representative. We appreciate your patience and understanding during this time and we remain committed to serving your needs.

    Attention:

    A recent cyber-security event experienced by Change Healthcare, one of the Benefit Funds’ vendors, has disrupted their ability to process disability, life insurance, and member reimbursements. This may cause a delay in payments. We apologize for the inconvenience and will provide updates as they become available. If you have any questions, please call Member Services at (646) 473-9200.

    Attention: Change Healthcare—one of the Benefit Funds’ vendors and a prominent healthcare technology provider linking providers, payers and patients—experienced a cyberattack on Wednesday, February 21. Although the cyberattack did not target the Benefit Funds’ systems, we immediately severed network connections with Change Healthcare to prevent potential risks to our members' data. As a result, we cannot exchange electronic transactions (including claims submissions, ERAs and EFTs) through Change Healthcare's platform.

    We do not know how long Change Healthcare will be unavailable. Therefore, we have begun identifying alternative payment, EDI, and other claims and payment service solutions to use in the interim. Please use the following services until further notice:

    Eligibility Verification

    NaviNet's online provider portal

    For customer support, including registration and technical assistance, please contact NaviNet directly at (888) 482-8057 or IVR at (888) 819-1199.

    Claims Submission

    Ability (Inovalon) Help Center


    The Funds Provider Relations Call Center is currently experiencing higher than normal call volumes, and you may have to wait longer than usual to reach a Representative. The Funds have many self-service options to support you. 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 [email protected].

    The physical offices of the 1199SEIU Training and Employment Funds (TEF) are closed to walk-in services, classes and intake sessions. TEF staff continues to work remotely and will update you via this website on issues of member payments and other services. See our Member Bulletin and Schedule Changes for important contact information and changes.

    Notice to 1199SEIU Providers and Hospitals: Coverage of Telehealth Services Made Permanent

    We 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. Please note: 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 05/12/2023, coverage determination will be made based on the Benefit Funds’ telehealth policy. The policy will be available shortly.

    70 Institutions

    1199SEIU members can receive care at more than 70 institutions throughout New York City, Westchester and Long Island.

    30,000 Participating Providers

    We share a mission with our participating providers: to help ensure that our members have access to quality healthcare. Join our provider network.

    400,000 Covered Lives

    The 1199SEIU Benefit Funds are some of the largest self-administered labor-management funds in the nation, providing health coverage for more than 400,000 union members, retirees and their families.

    Systems and Resources

      Eligibility and Claims Status

      Check eligibility and claims status on our NaviNet provider portal. Or access our Interactive Voice Response (IVR) system.

      Preferred Drug List

      Help your 1199SEIU patients avoid out-of-pocket costs by using the Preferred Drug List.

      Find a Provider

      Refer an 1199SEIU patient. Or confirm your own information.

      Prior Authorization

      You must get prior authorization for certain surgical procedures, prescriptions, equipment requests and hospital services.

      Claims

      Take the paperwork out of claims. Accelerate your reimbursement cycle.

      Recredentialing

      Don’t Jeopardize Your Participating Provider Status

      We are recredentialing our Provider Network and we need your help. Please update your CAQH application and your attestation form. Read More »

      Contact Us

      (646) 473-7160

       

      Quick Reference Guide

      Quickly find contact info for claims submission, prior authorization and other processes.

      Provider Documents

      Search for provider forms, drug lists, manuals and more.

      DocumentKey Words
      Limited Distribution Specialty Drug Listcovered prescriptions formulary drugs medications accredo acredo
      Allergy Benefit Extension Request
      Appendix B: Laboratory Guideline to Approved In-Office Laboratory Testsprovider manual clia tests in office in-office labs
      Benefit Fund Appeal Representation Authorization Formclaims appeals denial designate designation grant
      Cardiac/Pulmonary Rehabilitation Request
      CareAllies Initial Pre-Certification Requestcare allies pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization precertification certification pre-certification authorize authorizing
      CareContinuum Medical Drug Benefit Management Programcare continuum
      Medical Management for Chiropractic Services - Quick Reference Contact Sheet
      Medical Claim Reconsideration Requestclaims appeals
      eviCore Codes Requiring Authorizationpre prior authorization preauthorization priorauthorization pre-authorization prior-authorization out patients outpatients precertification certification pre-certification authorize authorizing
      Codes Under eviCore Radiation Therapy Review Programevi core carecore care pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization precertification certification pre-certification authorize authorizing
      Complete Code List under eviCore Laboratory Management Programevi core carecore care pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization precertification certification pre-certification authorize authorizing
      Co-Pays for Greater New York Memberswhat's what is the gny copays copayments co-payments for a primary care office visits appointments general family internal medicine practitioners pediatricians OB/GYNs geriatricians adolescent medicine providers prescriptions drugs medications preventive services
      eviCore Contrast Agents and Radiopharmaceuticalevi core carecore care pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization precertification certification pre-certification authorize authorizing
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      eviCore Radiation Therapy Clinical and Coding Guidelinesevicore evi core carecore care
      eviCore Radiation Therapy Clinical Documentation Requirementsevi core carecore care pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization precertification certification pre-certification authorize authorizing
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      FAQs: 2013 Behavioral Health Code Changes and the Mental Health Parity Lawevi core carecore care frequently asked questions
      Focus DRG Validation ProgramReadmission Review Programs
      Request for Home Oxygen Authorizationpre prior authorization preauthorization priorauthorization pre-authorization prior-authorization precertification certification pre-certification authorize authorizing
      HomeCare, Certain Outpatient, DME and Rx Servicesdurable medical equipment drugs covered prescriptions home care out patients outpatients medications pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization precertification certification pre-certification authorize authorizing
      Hospital Claim Reconsideration Request FormHCPCS icd10 icd-10 cpt drg appeals claims
      CareAllies Medical Management for Hospital Services - Quick Reference Contact Sheetcare allies
      IRS Form W-9w9 taxes
      Laboratory Management Clinical Policy Manualevi core carecore care pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization precertification certification pre-certification authorize authorizing
      CareContinuum Medical Drug Benefit Management Program Specialty Listcovered prescriptions formulary drugs medications ExpressPAth express path carecontinuum care continuum pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization precertification certification pre-certification authorize authorizing
      Outpatient Services and/or Ambulatory Surgical Procedures that Require Pre-Authorizationout patients outpatients pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization precertification certification pre-certification authorize authorizing
      Preferred Drug List (PDL)covered prescriptions formulary drugs medications prefered preferred
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      Radiology Privileging ListPrivileging standards by specialty cpt codes
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      Transcranial Magnetic Stimulation (TMS) Pre-Authorizationpre prior authorization preauthorization priorauthorization pre-authorization prior-authorization out patients outpatients precertification certification pre-certification authorize authorizing
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      Care Management Program Quick Reference Guideevi core carecore care pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization precertification certification pre-certification authorize authorizing quick reference guide frequently asked questions
      Prior Authorization for Intensive Outpatient or Partial Hospitalization Programspre prior authorization preauthorization priorauthorization pre-authorization prior-authorization authorize authorizing member assistance concurrent review intensive outpatient program partial hospitalization

      Provider Notice: Update to COVID-19 Benefits

      During the federal COVID-19 public health emergency (PHE), the Benefit Funds temporarily changed specific policies to ensure that your 1199SEIU patients had access to medical services during that challenging time. Following the recent expiration of the PHE declaration...

      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,...

      Provider Guides

      Quick Reference Guide

      Quickly find contact info for claims submission, prior authorization and other processes. Or see the full Provider Manual.

      Provider Manual

      Find answers to your questions about the Benefit Funds’ policies and procedures.

      Keep Your Information Up to Date

      Review the information we have on record for you, then submit any changes with the Provider Demographic Change Request Form along with a W-9.

      Please review the Provider Demographic Change Request Form Guide, which will assist you in completing the form.

      Further Resources