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 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].

Get Help Finding Alternative Child-care Services »

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.

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.

Enhancements to Eligibility & Benefits Are Here!

NantHealth and 1199SEIU Benefit Funds are excited to announce additional accumulator information for member benefits in Eligibility and Benefits is now here! Learn more.

Provider Notice/FAQ: COVID-19

Systems and Resources

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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.

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Keep Your Information Up to Date

Review the information we have on record for you, then submit any changes.

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.

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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

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(646) 473-7160

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[email protected]

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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.

Document	Key Words
Limited Distribution Specialty Drug List	covered prescriptions formulary drugs medications accredo acredo
Allergy Benefit Extension Request
Appendix B: Laboratory Guideline to Approved In-Office Laboratory Tests	provider manual clia tests in office in-office labs
Benefit Fund Appeal Representation Authorization Form	claims appeals denial designate designation grant
Cardiac/Pulmonary Rehabilitation Request
CareAllies Initial Pre-Certification Request	care allies pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization precertification certification pre-certification authorize authorizing
CareContinuum Medical Benefit Management Program	care continuum
Medical Management for Chiropractic Services - Quick Reference Contact Sheet
Medical Claim Reconsideration Request	claims appeals
eviCore Codes Requiring Authorization	pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization out patients outpatients precertification certification pre-certification authorize authorizing
Codes Under eviCore Radiation Therapy Review Program	evi 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 Program	evi core carecore care pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization precertification certification pre-certification authorize authorizing
Co-Pays for Greater New York Members	what'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 Radiopharmaceutical	evi 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 Codes	evi core carecore care pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization precertification certification pre-certification authorize authorizing
eviCore Laboratory Management Program FAQs	evi 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 List	covered 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 FAQs	evi 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 Guide	evi 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 Guidelines	evicore evi core carecore care
eviCore Radiation Therapy Clinical Documentation Requirements	evi 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 Guide	evi 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 FAQs	evi 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 Codes	pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization precertification certification pre-certification authorize authorizing evi core carecore care
eviCore Radiology Review Management Program	evi 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 FAQs	evi 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 Law	evi core carecore care frequently asked questions
Focus DRG Validation Program	Readmission Review Programs
Request for Home Oxygen Authorization	pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization precertification certification pre-certification authorize authorizing
HomeCare, Certain Outpatient, DME and Rx Services	durable 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 Form	HCPCS icd10 icd-10 cpt drg appeals claims
CareAllies Medical Management for Hospital Services - Quick Reference Contact Sheet	care allies
IRS Form W-9	w9 taxes
Laboratory Management Clinical Policy Manual	evi core carecore care pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization precertification certification pre-certification authorize authorizing
CareContinuum Medical Benefit Management Program Specialty Drug List	covered 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-Authorization	out 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 Authorization	covered prescriptions medications drugs pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization precertification certification pre-certification authorize authorizing
Provider Demographic Information Change Request Form Guide	how 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 Form	how do i we to change update add my our Billing service address? Business? Name? tax id tin w9 w-9 npi
Provider Manual	instructions help
Provider Quick Reference Guide	instructions help policy cheet sheet
Provider Recruitment Form	how do I we sign up
Radiation Therapy Prior Authorization and Claims Studio Procedure Codes	evi core carecore care pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization precertification certification pre-certification authorize authorizing
Radiation Therapy Tools and Criteria	evi 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 List	Privileging 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 Solution	90 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 Form	90 day maintenance covered prescriptions formulary drugs medications prefered preferred exception prior authuthorization priorauthorization prior-authorization preauthorization pre-authorization
Utilization Management Master Drug List	pre 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
Pharmacist Authority to Administer Vaccines by State	vaccinations vacines vacinations
Prescription Claims Reimbursement Form	covered prescriptions claims formulary drugs medications prefered preferred new york city lpn licensed practical nurses welfare fund hmo plans retail pharmacies pharmacy
Transcranial Magnetic Stimulation (TMS) Pre-Authorization	pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization out patients outpatients precertification certification pre-certification authorize authorizing
PT/OT/ST & Acupuncture Request	pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization precertification certification pre-certification authorize authorizing