In addition to participating hospital and certain specialty laboratories, the 1199SEIU Benefit Funds have a preferred arrangement with both Laboratory Corporation of America (LabCorp) and Quest Diagnostics for reference laboratory services.
It is important that you only refer members to participating laboratories to prevent balance billing by non-participating laboratories.
The Benefit Funds require prior authorization for certain outpatient molecular and genomic laboratory procedures, including genetic testing. For prior authorization details, visit our Laboratory Test page.
Approved In-office Tests
The 1199SEIU Benefit Funds have identified a list of laboratory tests that providers with a valid CLIA (Clinical Laboratory Improvement Amendments) waiver may conduct in their offices (see Laboratory Guidelines).
Please refer to Prescription Drug Services.
The 1199SEIU Benefit Funds have a preferred provider arrangement with the One Call Care Management Network to provide outpatient radiology services to our members. The network consists of a number of freestanding and facility-based sites nationally, including throughout New York and New Jersey, to provide routine radiology, MRI and CAT and PET scan services. (See the list of participating sites.)
The Benefit Funds require prior authorization for certain non-emergent tests, including MRIs, MRAs and CAT and PET scans when they are provided by a freestanding, office-based or outpatient hospital site. Referring or servicing providers may initiate requests for prior authorization through the Benefit Funds’ Radiology Review Program. Visit our Radiology Services page for details. Claims for codes that are not allowed or where services are rendered without prior authorization for a particular specialty will be denied, and Benefit Funds members may not be held responsible for these payments. Radiologists, diagnostic radiologists, radiation therapists and radiation oncologists may provide radiology services without restriction but are still required to obtain prior authorization for MRIs, MRAs and CAT and PET scans.
Non-radiology physicians will only be reimbursed for certain procedures, depending on their specialty. The Benefit Funds’ Radiology Privileging by Specialty guidelines list the radiology CPT codes in the “70000” series that will be payable to non-radiology physicians. If your Benefit Funds members need radiology services that are not payable for your specialty, you must refer them to a participating radiology provider.
Durable Medical Equipment (DME) Services
The 1199SEIU Benefit Funds have a preferred provider arrangement with Landauer Medstar, Inc., Apria Healthcare, Inc., and New York Home Health Care Equipment to provide outpatient DME services to our members. Within the preferred network, our members will have access to quality, cost-effective and medically necessary durable medical equipment.
Providers may submit an authorization request by fax to (646) 473-7447, or they may call the Benefit Funds’ Prior Authorization Department at (646) 473-7446. Learn more about preferred DME providers.
Phone: (800) 631-3031
Apria Healthcare Inc.
Phone: (800) 727-3958
New York Home Health Care Equipment
Phone: (516) 333-2473