Archive
Benefit Funds Partner with Zelis, Inovalon for Electronic Payment and Claims Services
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Healthy Living Resource Center Supports Members’ Wellness Journeys
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Important Alerts and Reminders
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Change Healthcare, Inovalon Provider Network FAQs
If I do not have access to the Inovalon Provider Network, how do I submit claims? Please inform your clearinghouse that the Benefit Funds now use the Inovalon Provider Network. Your clearinghouse should be able to establish a connection to route claims there. If I...
Ensure Faster Claims Processing by Using Correct Billing Codes
The National Correct Coding Initiative (NCCI), which promotes national correct coding methodologies and controls improper coding and incorrect payments for medical services, includes three types of edits: NCCI Procedure-to-Procedure Edits prevent inappropriate payment...
ClaimsXTen Select Is Now Lyric
The Benefit Funds’ claims auditing software ClaimsXten Select is now Lyric. Only the name—not the software—has changed. Lyric will continue to assess the appropriateness of professional and outpatient hospital claims against clinically based coding rules and edits,...
The Benefit Funds Credentialing Committee Seeks Board-certified Physicians
The Benefit Funds invite all board-certified participating providers with exemplary credentials and leadership qualities to join the 1199SEIU Benefit Funds Credentialing Committee. As a committee member, you would help ensure that the Benefit Funds maintain a...
The Benefit Funds Are Recredentialing Our Provider Network
The Benefit Funds are recredentialing our provider network and need your help to ensure that members have access to quality in-network healthcare providers. Please update your Council for Affordable Quality Healthcare (CAQH) application and your attestation form. You...
Important Alerts and Reminders
Aetna Choice POS II has been the wraparound network supplementing the Benefit Funds’ directly contracted network for coverage outside New York City since March 2, 2023. Aetna Choice POS II New York City provider locations are considered nonparticipating. Members must...
Change Healthcare Is the Benefit Funds’ Exclusive EDI Partner Effective May 15
The Benefit Funds previously shared information about consolidating Electronic Data Interchange (EDI) clearinghouses into a single gateway through our partnership with Change Healthcare. This consolidation became effective May 15. All clearinghouses and billing...
The Benefit Funds Have Partnered with Healthix for Access to Health Information Exchange
Through our partnership with Healthix, the Benefit Funds have access to key health information about our members’ healthcare. This allows the Benefit Funds to identify health gaps and enable clinical outcome trend analysis for its “Healthy Living” initiative. Please...
The Benefit Funds Support Members on Their Next Steps on Their Health Journeys
The Benefit Funds have partnered with WeightWatchers® to support members’ health journeys, including helping those with chronic conditions. According to WeightWatchers, its programs are proven to help those with diabetes control their blood sugar (measured by HbA1c)...
The Benefit Funds Offer Virta to Help Members Potentially Reverse Their Type 2 Diabetes
In April, the Benefit Funds launched access to Virta, a program with a medically based approach to reduce A1C levels and potentially even reverse type 2 diabetes without medications or surgery. Virta will be offered at no cost to eligible 1199SEIU members and their...
Enhancement to Medical Drug Benefit Program Managed by CareContinuum, Effective January 1, 2023
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Benefit Funds Expand Partnership with eviCore to Include Clinical Trial Management, Effective January 1, 2023
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Remember to Always Refer to the Benefit Funds’ Preferred Drug List and to Update Your Provider Demographic Information
Updated eviCore Cardiology and Radiology Imaging Clinical Guidelines Effective October 1
eviCore Healthcare has released an update to its evidenced-based clinical guidelines for cardiology and radiology imaging services that will be effective October 1, 2022. Please visit the cardiology and radiology solutions page of eviCore’s website and click on the...
Coming in 2023: Benefit Funds to Consolidate EDI Claim Submission with Change Healthcare
As part of our efforts toward continuous improvement, the 1199SEIU Benefit Funds will be consolidating electronic data interchange (EDI) clearinghouses into a single gateway. In early 2023, Change Healthcare will be our exclusive EDI gateway provider. All...
Ensure Your Provider Directory Demographic Information Is Current
Under the federal No Surprises Act (NSA), providers are required to ensure that their demographic information in provider directories is accurate. If you have any updates to your demographic information, such as changes in service locations, billing information, phone...
Photographs of Providers Added to Provider Directory
Patients who search provider directories often like to see photographs of healthcare providers, in addition to information such as names, specialties and locations. In response, the Benefit Funds have begun uploading photographs to our online provider directory. If...
Verify Your 1199SEIU Patients’ Eligibility and Check Their Claims Online
We know how important it is for providers to have access to real-time information on their 1199SEIU patients’ claims status and eligibility for services. That’s why we offer a quick and convenient way for you to view this information online, through NaviNet, the...
Updates to Claims Auditing Software
In the coming months, the 1199SEIU Benefit Funds’ ClaimsXten Select Claims auditing software system will be updated to include Medically Unlikely Edits (MUEs), which prevent payment for an inappropriate number/quantity of the same service on a single day. An MUE for...
Provider Notice/FAQs: Federal No Surprises Act
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Benefit Funds to Upgrade Our Claims Auditing Software
Effective March 1, the Benefit Funds will upgrade our claims-auditing platform, from ClaimCheck to ClaimsXten, to meet our needs for a more comprehensive and well-known solution that is used by many payers to adjudicate applicable claims according to prevailing...
Notice to 1199SEIU Providers and Hospitals: Coverage of Telehealth Services Made Permanent
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Coming Soon to eviCore Medical Oncology
Enhancements Coming October 1, 2021 New cancer treatments are entering the market at an unprecedented pace. Since 2018, the U.S. Food and Drug Administration (FDA) has approved more than 136 new cancer indicators, including 53 novel cancer drug entities. The FDA has...
Enhancements to eviCore Streamline Prior Authorization Process
The 1199SEIU Benefit Funds are enhancing their partnership with the eviCore Healthcare Review Program to help ensure that your 1199SEIU patients receive the most consistent standard of cancer care. These changes, which will go into effect on October 1, include...
The Benefit Funds Have Your 1199SEIU Patients Covered During the COVID-19 Pandemic
During this COVID-19 pandemic, the Benefit Funds have worked to support the care that you, our valued partners, provide to your 1199SEIU patients by helping to ensure they can access the testing and medical care they need. The Funds are covering diagnostic testing for...
Your 1199SEIU Patients Are Covered for Certain Coronavirus and Antibody Tests
The Benefit Funds are covering diagnostic testing for the coronavirus, as well as antibody testing when medically necessary, for your 1199SEIU patients. The Funds will not cover employment-related tests, antibody tests when there was a previously confirmed COVID-19...
Provider Notice: Update to COVID-19 Benefits
During the federal COVID-19 public health emergency (PHE), the Benefit Funds temporarily changed specific policies to ensure that your 1199SEIU patients had access to medical services during that challenging time. Following the recent expiration of the PHE declaration...
Provider Notice/FAQ: COVID-19 During PHE
In response to the COVID-19 pandemic, the Benefit Funds have temporarily changed certain policies to help ensure your 1199SEIU patients have access to medical services during the federal COVID-19 Public Health Emergency (PHE). Be sure to check the Funds website for...