Claims

Electronic Claims

We accept all claims submissions electronically through Change Healthcare (formerly known as Emdeon and Capario), 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:
    • For dental services provided to National Benefit Fund members before April 1, 2017, send ADA claims to: PO Box 1149, New York, NY 10108-1149.
    • For dental services provided to National Benefit Fund members on or after April 1, 2017, contact EmblemHealth.
    • As of April 1, 2017, please check the EmblemHealth Preferred Dental Plan ID cards for the dental carrier of your National Benefit Fund members. This EmblemHealth ID number must be included on all claims submitted to EmblemHealth for DOS on or after April 1, 2017.

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 your checks to arrive in the mail. Plus, it eliminates manual processes like sorting and opening mail, reconciling paper-based claims payments, creating deposit tickets and making trips to the bank.

Simplify Reconciliation
Once enrolled in ePayment, you will continue to receive paper Explanation of Payment (EOP) statements for up to 45 days after enrollment, after which the 1199SEIU 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

ClaimCheck

On January 1, 2017 the 1199SEIU Benefit Funds updated the comprehensive claims auditing software utilizing ClaimCheck 10.2, Knowledge Base 59, with National Correct Coding Initiative (NCCI ) version 23.0. As we previously communicated, the Benefit Funds adhere to the NCCI guidelines, developed by the Centers for Medicare & Medicaid Services (CMS) to promote correct coding methodologies and limit improper coding and related inappropriate payments. For additional information on NCCI, please visit the CMS website at cms.gov/medicare/coding/nationalcorrectcodinited/ncci-coding-edits.html.

Questions?

Email us at Providers@1199Funds.org. or call our Provider Services Representatives at (646) 473-7160.