CVS logo

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

Preferred Drug List

Avoid out-of-pocket costs by using only preferred drugs on the Funds’ Preferred Drug List.

90

Day

90-Day RX Solution

For Long-Term Medications, Members Must Use the 90-Day RX Solution.

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

Most Claims Operations Restored after Cyberattack on Change Healthcare

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

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

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.

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

Change Healthcare, Inovalon Provider Network FAQs Provider Notice: Update to COVID-19 Benefits

Systems and Resources

    N

    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.

    l

    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.

    i

    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

     

    [email protected]

     

    h

    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.

    Read More Provider Connections

    Quick Links

    Provider Guides

    h

    Quick Reference Guide

    Quickly find contact info for claims submission, prior authorization and other processes. Or see the full Provider Manual.
    h

    Provider Manual

    Find answers to your questions about the Benefit Funds’ policies and procedures.

    h

    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


    NaviNet


    Find a Provider

    Check Your Claims


    Electronic Payments

    CONTACT US

    (646) 473-7160
    [email protected]
    Quick Reference Guide
    Become a Provider