Dear 1199SEIU Provider:

Welcome to the 1199SEIU Benefit Funds Provider Manual, where you’ll find a helpful overview of our members’ covered health services. We understand that the 1199SEIU Benefit Funds’ extensive network of talented providers is integral to the quality of service we’re able to provide. We’re delighted you are part of our network, and we are committed to working with you to ensure our members receive quality care.

The advantages to participating in the 1199SEIU Benefit Funds’ network include:

• Participation in a provider network of 70 hospitals and over 40,000 providers
• A dedicated Provider Relations Department to handle your questions or concerns
• Lower administrative costs with electronic claims processing and electronic fund transfer payments
• No deductibles and no co-payments for participants in the 1199SEIU National Benefit Fund for Health and Human Service Employees, and minimal co-payments for participants in the 1199SEIU Greater New York Benefit Fund and the 1199SEIU National Benefit Fund for Home Care Employees
• Automated eligibility verification and claims status 24 hours a day, seven days a week, through our online provider portal NaviNet and our Interactive Voice Response (IVR) system at (888) 819-1199
• Effortless credentialing and re-credentialing, including delegated credentialing where appropriate
• Regular updates, notices and alerts via our Provider Connections e-newsletter

Because we regularly update our list of services requiring prior authorization, please check the For Providers area of our website, including our Prior Authorization page, for the most current information and read our Provider Connections e-newsletters, created to serve your needs.

We look forward to working with you and your staff. Our Provider Relations team is always here to answer your questions—just call (646) 473-7160 or email [email protected].

Sincerely,

Donna Rey, EdD

Our 1199SEIU Provider Quick Reference Guide is a handy resource that includes some of the most frequently requested information. We recommend bookmarking the page and/or downloading a copy. For your convenience, here are some of the topics covered and direct links to useful forms and information:

• Become a participating provider: Provider Recruitment Form
• Provider practice changes: Provider Demographic Information Change Request Form
• Claims submission: www.ChangeHealthcare.com, payer ID# 13162
• Electronic fund transfer (EFT) payments: processed through Change Healthcare; enroll in the Change Healthcare EFT service

The 1199SEIU Benefit Funds are among the largest self-administered, joint labor–management funds in the country. We are not an insurance company. We are not-for-profit organizations providing healthcare and other benefits to 1199SEIU healthcare workers, retirees and their eligible dependents covered by the 1199SEIU Benefit Funds—nearly 450,000 lives in total.

While the Benefit Funds are jointly administered, it is important to note that benefits and coverage vary between discrete Benefit Funds. Employer contributions to the Benefit Funds pay for the cost of benefits. The Benefit Funds’ goal is to provide members with access to quality, cost-effective healthcare with few, if any, out-of-pocket costs.

This manual, along with each Benefit Fund’s Summary Plan Description, covers the benefits and services available to 1199SEIU members in the 1199SEIU National Benefit Fund for Health and Human Service Employees, the 1199SEIU Greater New York Benefit Fund and the 1199SEIU National Benefit Fund for Home Care Employees. These Benefit Funds contract directly with you as a participating provider. For more information, please visit the About Us area of our website.