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Spring 2008
Your Key to the 1199SEIU Benefit Funds
Message from the Executive Director
Another Way We Are Making Online Claims Easier The 1199SEIU Benefit Funds are proud to offer our providers another way to submit claims electronically. In addition to MD OnLine (www.1199mdol.com) and Emdeon ( w w w.e m d e o n .c o m ) , you c a n now submit claims through Me d Ava nt at www.medavanthealth.com or (800) 792-5256. These services save you time and increase claim accuracy. You’ll still need your Provider ID number and member billing ID, which are both available on our website at www.1199SEIUFunds.org – just click on “For Providers.” If you have any questions, please call our Provider Hotline at (646) 473-7160.
As many of you already know, in April a group of our members – our Home Care workers, group 199H – will be moving to a state-funded plan with Fidelis Care. While we’ll continue to pay claims for these members through March 31, after that time their claims will be processed through the Fidelis network. If you are not already in Fidelis Care’s network, we urge you to join. You will find information in this edition of 1199SEIU Provider Connections on just how to do that. However, we do want to remind you that we will continue to pay the majority of our members’s claims – our National Benefit and Greater New York Funds – directly. Also, in this issue of 199SEIU Provider Connections, you’ll see some important updates to our prior authorization requirements, as well as information about new ways to submit electronic claims and check your claims status quickly and easily. And since we’re also committed to providing our members with the strongest, most qualified provider network, we invite you to help us by participating as a peer reviewer on our Credentialing Committee. We’ll continue to work on ways to strengthen our network and our service to you, and to ensure that together, we’re providing our members with the high-quality medical care they need and deserve. Mitra Behroozi
Important Update: Your 1199SEIU Home Care Fund Patients – Group 199H – Are Moving to the Fidelis Network on April 1 In order to restore and preserve benefits for our 1199SEIU Home Care members, we have partnered with New York state and Fidelis Care to participate in the Family Health Plus and Child Health Plus programs. About 78,000 of our Home Care members will now be utilizing Fidelis Care’s network of providers. Please note that this change will affect 1199SEIU Home Care member s ONLY ( group 199H ) . Coverage for any of your patients in the National Benefit Fund and Greater New York Benefit Fund will continue without change. Continuity of care is important to us and to our members. We hope that you are already a Fidelis provider, but if you are not, Fidelis Care has authorized the Benefit Fund to invite you to participate in their provider network. We hope you will accept our invitation to join Fidelis Care’s network so that you can continue to provide quality care to our Home Care members. For more information about joining Fidelis Care’s network, visit www.fideliscare.org or call Fidelis Care at (718) 393-6337. If you’re currently treating an 1199SEIU Home Care member for a serious condition and you are not in the Fidelis Care network, call (888) FIDELIS [888-343-3547] after April 1 to discuss your patient’s situation with a member service representative. Fidelis Care will work with you during the course of the treatment and help your patient transition to a participating doctor when appropriate.
Reminder: Physical Therapy, Occupational Therapy and Speech Therapy Limited to 25 Visits Per Year The Benefit Fund allows 1199SEIU patients up to 25 physical, occupational or speech therapy visits per calendar year. All treatments must be medically necessary and in compliance with established clinical guidelines. If you have any questions, please contact the Care Management Call Center at (646) 473-7160, Monday to Friday between 9:00 AM and 5:00 PM.
Stay Updated by Checking Our Website Our comprehensive website is the perfect resource for you and your staff to stay updated and informed on new forms, lists and announcements. You also can update your information online so that we always have the most current information available. Be sure to visit us at www.1199SEIUFunds.org.
Don’t Forget to Use Your National Provider Identifier All providers are now federally required to use their National Provider Identifier (NPI) for their claims. If you have not done so already, you can submit your NPI to the Benefit Fund online by visiting our website at www.1199SEIUFunds.org and clicking on “For Providers.” Make sure you include your 10-digit federal NPI, as well as your Benefit Fund Plan Provider ID number and tax ID number, to avoid any delays in processing your claims. Complete, accurate information helps us better serve you.
Important Update: EMG/NCV and Foot Orthotics No Longer Require Prior Authorization
Checking Claim Status Is Easy With Our Automated System
Please be advised that as of 1/1/2008, EMG/ NCV (electromyography/nerve conduction velocity studies) and foot orthotics no longer require prior authorization by the Benefit Fund. EMGs can be covered for up to two (2) dates of service per calendar year. Foot orthotics (L3000, L3010, L3020, L3030) can be covered for a specific diagnosis every two years; 2008 is the transition year for this benefit. Children can be covered for a specific diagnosis each year. Please note that Oxford shoes are not covered.
With the Benefit Funds’ automated system, you have claim status at your fingertips 24 hours a day, 7 days a week by using the same number to check eligibility. You can check claim status quickly and conveniently with this system. Just call (888) 819-1199 and have your tax ID number, member ID number and the member’s date of birth on hand. We hope that you take advantage of another way that the Benefit Fund is improving our services to you.
Help Strengthen Our Provider Network A network is only as strong as its providers. If you are a board-certified participating provider, you have the chance to help the 1199SEIU Benefit Funds by becoming a peer reviewer. Our Credentialing Committee is still in the process of re-credentialing our providers and could use your expertise. To join the Committee, or for more information, please contact Stephanie Price at sprice@1199funds.org.