Provider Resources

Provider Manual

This manual is a comprehensive reference guide that explains the policies and coverage of the 1199SEIU Benefit Funds. Along with your provider agreement and each Benefit Fund’s Summary Plan Description (SPD), this manual outlines your responsibilities under your contract with the Benefit Funds and replaces all earlier manuals and alerts. We will also send you updates periodically through provider notices and our Provider Connections e-newsletter.

If there is a discrepancy between the Provider Manual and the SPD, the SPD will be the final authority.

Provider Relations Department

Our Provider Relations Department assists providers with their questions or concerns and helps ensure that all providers comply with the 1199SEIU Benefit Funds’ policies and procedures. Our Provider Relations Representatives are available for virtual or onsite support, education and recruitment visits. You may contact your Provider Relations Representative directly or write to [email protected].

Self-service Tools

Visit the NaviNet provider portal to access the Benefit Funds’ eligibility and benefits information, including services with visit maximums and confirmation of visits remaining; claim status; claim adjudication details; and downloadable copies of explanation of payment (EOP) statements, where available. In addition to NaviNet, our Interactive Voice Response (IVR) system is available to you 24 hours a day, 7 days a week. You can use it to check claim status and member eligibility. Just call (888) 819-1199.

To access eligibility and benefits verification on NaviNet, you will need the member’s ID number or patient’s first and last name as it appears on the member’s Health Benefits ID card and date of birth.

You will need the following information to access claim status:

  • Claim ID number
  • Servicing provider NPI
  • Billed claim amount
  • Member’s ID number
  • Patient’s date of birth

Provider Connections E-Newsletter and Notices

The 1199SEIU Benefit Funds issue a Provider Connections e-newsletter and periodic notices to communicate policy changes and to disseminate general information to providers.

The 1199SEIU Benefit Funds Website

The 1199SEIU Benefit Funds website is a valuable resource for providers and the place to go to for the most up-to-date directories, notices, forms, benefit plan descriptions and other useful information, as well as to review your information to ensure it’s up to date. Visit the For Providers area of our site to get started.