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 with our automated 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
    Accredo Specialty Drug List (Limited Distribution Network)covered prescriptions formulary drugs medications
    Accredo Specialty Drug Listcovered prescriptions formulary drugs medications
    Accredo Split-Fill Drug Listcovered prescriptions formulary drugs medications split fill
    Allergy Benefit Extension Request
    Appendix B – Laboratory Guidelinesprovider manual clia tests in office in-office
    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
    Drug Quantity Management (DQM) Listcovered prescriptions formulary drugs medications
    Drugs Requiring Prior Authorizationcovered prescriptions formulary drugs medications pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization precertification certification pre-certification authorize authorizing
    EmblemHealth Preferred Dental Transition of Care Formdental dentistry Emblem Health
    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 Management Programevi core carecore care pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization precertification certification pre-certification authorize authorizing
    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 Quick Reference Guideevi core carecore care pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization precertification certification pre-certification authorize authorizing
    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 Programevi 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
    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
    Step Therapy Drug Listcovered prescriptions formulary drugs medications
    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

    Quick Links

    Provider Guides

    Provider Connections

    Your key to the 1199SEIU Benefit Funds.

    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