Most Claims Operations Restored after Cyberattack on Change Healthcare

    Attention: The February 21, 2024, cyberattack on Change Healthcare disrupted the Benefit Funds’ and providers’ claims submission and reimbursement processes. The Benefit Funds have now fully restored most of our claims operations and are able to receive claims and issue payments through our partnerships with ABILITY and Zelis.

    For now, the Benefit Funds are not issuing electronic payments. All payments are being issued via paper check, along with a paper remittance advice. While this solution allows us to continue fulfilling our payment obligations, we understand the inconvenience it may cause and are working to resume processing electronic payments as soon as possible.

    Eligibility Verification

    NaviNet's online provider portal

    For customer support, including registration and technical assistance, please contact NaviNet directly at (888) 482-8057 or the 1199SEIU Interactive Voice Response system at (888) 819-1199.

    Claims Submission

    ABILITY (Inovalon) Help Center

    Check Eligibility, Benefit and Claim Status Information with Self-Service Options

    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].

    Telehealth Services Continue to Be Covered

    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.

    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.

    CVS logo

    Effective July 1, 2024, CVS Caremark is the new Pharmacy Benefits Manager for the 1199SEIU Benefit Funds.

    For medical exceptions to the CVS Caremark 1199SEIU PDL, including brand-name drug requests and CVS Caremark drug exclusions, please call (866) 814-5506.

    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 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.