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.

The Funds Provider Relations Call Center is currently operating under our Essential Servicing Plan due to protocols surrounding the coronavirus (COVID-19).

During this time, you may experience a longer than usual wait time to reach a Service Representative. Voicemail messages left for a Provider Relations Call Center Representative will be returned within 48 hours. 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 “For Providers” section of our website for important updates.

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—We Now Cover Telehealth Services

Please note that effective March 18, 2020, we are temporarily 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 visits via phone, video and other virtual means for all eligible medical and mental health services, including COVID-19 related services until June 15, 2020.

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.

Verify 1199SEIU patient eligibility, claims status and much more.

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 Benefit Management Programcare continuum
    Medical Management for Chiropractic Services - Quick Reference Contact Sheet
    Medical Claim Reconsideration Requestclaims appeals
    Codes Requiring Prior 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
    eviCore Radiology and Cardiology Diagnostic Claims Studio Procedure Codesevi core carecore care pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization precertification certification pre-certification authorize authorizing
    eviCore Laboratory Management Program FAQsevi core carecore care pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization precertification certification pre-certification authorize authorizing frequently asked questions
    eviCore Medical Oncology Primary and Supportive Drug Listcovered prescriptions medications evi core carecore care pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization precertification certification pre-certification authorize authorizing oncology primary and supportive therapies drugs list clinical pathway precertification certification pre-certification reference document
    eviCore Medical Oncology Review Program FAQsevi core carecore care pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization precertification certification pre-certification authorize authorizing quick reference guide frequently asked questions
    eviCore Lab Management Quick Reference Guideevi core carecore care pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization precertification certification pre-certification authorize authorizing laboratory laboratory
    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
    eviCore Radiation Therapy 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
    eviCore Radiation Therapy Review Program FAQsevi core carecore care pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization precertification certification pre-certification authorize authorizing frequently asked questions
    eviCore Radiology and Cardiology Diagnostic Services Prior Authorization Procedure Codespre prior authorization preauthorization priorauthorization pre-authorization prior-authorization precertification certification pre-certification authorize authorizing evi core carecore care
    eviCore Radiology Review Management Programevi core carecore care pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization precertification certification pre-certification authorize authorizing quick reference guide
    eviCore Radiology Review Program FAQsevi core carecore care pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization precertification certification pre-certification authorize authorizing frequently asked questions
    FAQs: 2013 Behavioral Health Code Changes and the Mental Health Parity Lawevi core carecore care frequently asked questions
    Focus DRG Validation Program
    Home Oxygen Therapy Request for 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 Claims Reconsideration 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
    Letter to Members Regarding Emdeon
    CareContinuum Medical Benefit Management Program Specialty Drug 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
    CareAllies Outpatient and Home Care Services - Quick Reference Contact Sheetout patients outpatients homecare care allies guide
    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
    Prescription Request for Authorizationcovered prescriptions medications drugs pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization precertification certification pre-certification authorize authorizing
    Provider Demographic Information Change Request Form Guidehow do i we to change update add my our Billing service address? Business? Name? tax id tin w9 w-9 npi instructions help guide guidance
    Provider Demographic Information Change Request Formhow do i we to change update add my our Billing service address? Business? Name? tax id tin w9 w-9 npi
    Provider Manualinstructions help
    Provider Quick Reference Guideinstructions help policy cheet sheet
    Provider Recruitment Form Updatedhow do I we sign up
    PT/OT/ST Benefit Extensionphysical occupational step therapy
    Radiation Therapy Prior Authorization and Claims Studio Procedure Codesevi core carecore care pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization precertification certification pre-certification authorize authorizing
    Radiation Therapy Tools and Criteriaevi core carecore care pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization precertification certification pre-certification authorize authorizing
    Radiology Criteria (eviCore healthcare’s evidence-based clinical guidelines)evi core carecore care pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization precertification certification pre-certification authorize authorizing policy
    Radiology Privileging ListPrivileging standards by specialty cpt codes
    Service/Equipment Request for Authorization pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization precertification certification pre-certification authorize authorizing
    The 90-Day Rx Solution90 day covered prescriptions drugs medications
    NYC PICA Drug List (for LPN Members and NYC municipal employees only)covered prescriptions formulary drugs medications prefered preferred new york city lpn licensed practical nurses welfare fund
    90-Day Rx Solution Maintenance Drug Access Program Waiver Request Form90 day maintenance covered prescriptions formulary drugs medications prefered preferred exception prior authuthorization priorauthorization prior-authorization preauthorization pre-authorization
    Utilization Management Master Drug Listpre prior authorization preauthorization priorauthorization pre-authorization prior-authorization outpatients precertification certification pre-certification authorize authorizing um accredo acredo pica nyc employees new york city qty quantity limited express scripts expressscripts evicore evi core cancer oncology split fill step therapy client

    Verify Your 1199SEIU Patients’ Eligibility and Claims Online

    We know how important it is for our participating providers to have access to real-time information on their 1199SEIU patients’ claims status and eligibility for services. That’s why we offer a quick and convenient way for you to view this information online, through...

    No Prescription or Referral Required for Annual Mammogram

    At the Benefit Funds, we support the care you provide our 1199SEIU members by reminding them to stay current with their annual preventive screenings, including mammograms for women between ages 40 and 80. As you know, the procedure is a vital tool in helping to detect...

    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.

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