Dental Benefits Now Administered by EmblemHealth for National Benefit Fund Members

Effective April 1, 2017, EmblemHealth will administer dental benefits for 1199SEIU National Benefit Fund for Health and Human Service Employees (NBF), and the NBF’s own dental network will no longer be maintained.

The NBF will honor any claims from providers in our network for dental services performed before April 1, 2017. Claims for dental services performed on or after April 1, 2017, must be submitted to EmblemHealth for processing, in accordance with the new EmblemHealth contract. Claims submitted by providers who are not participating providers with the EmblemHealth Preferred Dental network will be paid according to EmblemHealth’s out-of-network reimbursement schedule, and payment will be sent to the patient. There is no assignment of benefits for non-participating providers. The NBF values your service as a participating provider and encourages you to join the EmblemHealth network, if you are not already a member, in order to continue to provide dental care to NBF members and beneficiaries.

If you are currently a non-participating provider in the EmblemHealth Preferred Dental network, the network will contact you directly to initiate the recruitment process. You may also contact EmblemHealth’s dental provider network management services via email at DentalProviders@EmblemHealth.com, or visit the Dental Provider Resources section of EmblemHealth’s website, where you will find documents for participation.

If you are not a participating provider in EmblemHealth’s network and have an NBF patient who requires continuing orthodontia treatment or follow-up care after major surgery, please ask the patient to complete and submit an EmblemHealth Transition of Care Request Form. You will also need to submit a new pre-determination of benefits for orthodontic treatment to EmblemHealth.

We look forward to working with you to ensure minimal disruption during this transition and to assist you in continuing to provide quality dental care to your NBF patients. If you have any questions regarding this notice, please contact our Provider Relations Call Center, Monday through Friday, from 8:00 am to 6:00 pm, at (646) 473-7160.