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 Providers@1199Funds.org.

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.

EviCore manages the Benefit Funds’ Medical Specialty Drug Prior Authorization Program

Effective March 1, 2025, EviCore manages the 1199SEIU Benefit Funds’ Medical Specialty Drug Prior Authorization Program. EviCore performs prior authorizations for certain medical drugs that are bought, billed and administered in an outpatient setting or gene therapies in an inpatient setting. Providers must contact EviCore for prior authorization before administering specialty drugs to their 1199SEIU patients.

Learn more about the Medical Specialty Drug Prior Authorization Program.