Claim Submission and Billing

Electronic Claims

We accept all claim submissions electronically through Change Healthcare (formerly known as Emdeon, Capario and RelayHealth) and Ability (formerly known as MD-Online).

Our payor number is 13162.

Paper Claims

  • Send UB04 claims to: PO Box 933, New York, NY 10108-0933
  • Send CMS 1500 claims to: PO Box 1007, New York, NY 10108-1007
  • For ADA claims:
    • The Benefit Funds do not administer dental benefits for 1199SEIU members. Please review your 1199SEIU patient’s dental identification card to identify the carrier and locate associated contact information for that carrier.

Electronic Payments

The 1199SEIU Benefit Funds have selected Change Healthcare (formerly known as Emdeon and Capario) as their electronic payment and remittance reporting provider. There is no cost to you to use Change Healthcare ePayment and enrollment is free.

Get Paid Faster with EFT payments

With Change Healthcare ePayment, you can accelerate your reimbursement cycle since you don’t have to wait for checks to arrive in the mail. In addition, it eliminates manual processes such as sorting and opening mail and reconciling paper-based claim payments.

Simplify Reconciliation

Once enrolled in ePayment, you will continue to receive paper Explanation of Payment (EOP) statements for up to 45 days, after which the Benefit Funds will generate a downloadable HIPAA-formatted 835 ERA file through your respective clearinghouse. You can also use Change Healthcare Payment Manager, an online application available for Change Healthcare ePayment users, to view and print EOP images.

Enroll in Change Healthcare/Emdeon

Claim Editing Rules

About ClaimsXten: On March 1, 2021, the 1199SEIU Benefit Funds upgraded the comprehensive claims auditing software to ClaimsXten version 2.2.2. ClaimsXten utilizes the National Correct Coding Initiative (NCCI), which includes the Procedure-to-Procedure (PTP) and Outpatient Code Editor (OCE) edits, as well as Medically Unlikely Edits (MUEs). The NCCI was developed by the Centers for Medicare & Medicaid Services (CMS) to promote correct coding methodologies and limit improper coding and other inappropriate reimbursements. All code and NCCI data is updated quarterly, at a minimum. For additional information on NCCI, please visit the CMS website here.ClaimsXten: Information and FAQ

Questions?

Email us at [email protected]. or call our Provider Services Representatives at (646) 473-7160.