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70 Institutions
1199SEIU members can receive care at more than 70 institutions throughout New York City, Westchester and Long Island.
30,000 Participating Providers
We share a mission with our participating providers: to help ensure that our members have access to quality healthcare. Join our provider network.
400,000 Covered Lives
The 1199SEIU Benefit Funds are some of the largest self-administered labor-management funds in the nation, providing health coverage for more than 400,000 union members, retirees and their families.
Systems and Resources
Eligibility and Claims Status
Check eligibility and claims status on our NaviNet provider portal. Or access our Interactive Voice Response (IVR) system.
Preferred Drug List
Help your 1199SEIU patients avoid out-of-pocket costs by using the Preferred Drug List.
Keep Your Information Up to Date
Find a Provider
Refer an 1199SEIU patient. Or confirm your own information.
Prior Authorization
You must get prior authorization for certain surgical procedures, prescriptions, equipment requests and hospital services.
Claims
Take the paperwork out of claims. Accelerate your reimbursement cycle.
Recredentialing
Don’t Jeopardize Your Participating Provider Status
We are recredentialing our Provider Network and we need your help. Please update your CAQH application and your attestation form. Read More »
Contact Us
(646) 473-7160
Quick Reference Guide
Quickly find contact info for claims submission, prior authorization and other processes.
Provider Documents
Search for provider forms, drug lists, manuals and more.
Document | Key Words |
---|---|
Limited Distribution Specialty Drug List | covered prescriptions formulary drugs medications accredo acredo |
Allergy Benefit Extension Request | |
Appendix B: Laboratory Guideline to Approved In-Office Laboratory Tests | provider manual clia tests in office in-office labs |
Benefit Fund Appeal Representation Authorization Form | claims appeals denial designate designation grant |
Cardiac/Pulmonary Rehabilitation Request | |
CareAllies Initial Pre-Certification Request | care allies pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization precertification certification pre-certification authorize authorizing |
CareContinuum Medical Drug Benefit Management Program | care continuum |
Medical Management for Chiropractic Services - Quick Reference Contact Sheet | |
Medical Claim Reconsideration Request | claims appeals |
eviCore Codes Requiring Authorization | pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization out patients outpatients precertification certification pre-certification authorize authorizing |
Codes Under eviCore Radiation Therapy Review Program | evi core carecore care pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization precertification certification pre-certification authorize authorizing |
Complete Code List under eviCore Laboratory Management Program | evi core carecore care pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization precertification certification pre-certification authorize authorizing |
Co-Pays for Greater New York Members | what's what is the gny copays copayments co-payments for a primary care office visits appointments general family internal medicine practitioners pediatricians OB/GYNs geriatricians adolescent medicine providers prescriptions drugs medications preventive services |
eviCore Contrast Agents and Radiopharmaceutical | evi core carecore care pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization precertification certification pre-certification authorize authorizing |
eviCore Radiology and Cardiology Diagnostic Claims Studio Procedure Codes | evi core carecore care pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization precertification certification pre-certification authorize authorizing |
eviCore Laboratory Management Program FAQs | evi core carecore care pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization precertification certification pre-certification authorize authorizing frequently asked questions |
eviCore Medical Oncology Primary and Supportive Drug List | covered prescriptions medications evi core carecore care pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization precertification certification pre-certification authorize authorizing oncology primary and supportive therapies drugs list clinical pathway precertification certification pre-certification reference document |
eviCore Medical Oncology Review Program FAQs | evi core carecore care pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization precertification certification pre-certification authorize authorizing quick reference guide frequently asked questions |
eviCore Lab Management Quick Reference Guide | evi core carecore care pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization precertification certification pre-certification authorize authorizing laboratory laboratory |
eviCore Radiation Therapy Clinical and Coding Guidelines | evicore evi core carecore care |
eviCore Radiation Therapy Clinical Documentation Requirements | evi core carecore care pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization precertification certification pre-certification authorize authorizing |
eviCore Radiation Therapy Management Program Quick Reference Guide | evi core carecore care pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization precertification certification pre-certification authorize authorizing quick reference guide |
eviCore Radiation Therapy Review Program FAQs | evi core carecore care pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization precertification certification pre-certification authorize authorizing frequently asked questions |
eviCore Radiology and Cardiology Diagnostic Services Prior Authorization Procedure Codes | pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization precertification certification pre-certification authorize authorizing evi core carecore care |
eviCore Radiology Review Management Program | evi core carecore care pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization precertification certification pre-certification authorize authorizing quick reference guide |
eviCore Radiology Review Program FAQs | evi core carecore care pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization precertification certification pre-certification authorize authorizing frequently asked questions |
FAQs: 2013 Behavioral Health Code Changes and the Mental Health Parity Law | evi core carecore care frequently asked questions |
Focus DRG Validation Program | Readmission Review Programs |
Request for Home Oxygen Authorization | pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization precertification certification pre-certification authorize authorizing |
HomeCare, Certain Outpatient, DME and Rx Services | durable medical equipment drugs covered prescriptions home care out patients outpatients medications pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization precertification certification pre-certification authorize authorizing |
Hospital Claim Reconsideration Request Form | HCPCS icd10 icd-10 cpt drg appeals claims |
CareAllies Medical Management for Hospital Services - Quick Reference Contact Sheet | care allies |
IRS Form W-9 | w9 taxes |
Laboratory Management Clinical Policy Manual | evi core carecore care pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization precertification certification pre-certification authorize authorizing |
CareContinuum Medical Drug Benefit Management Program Specialty List | covered prescriptions formulary drugs medications ExpressPAth express path carecontinuum care continuum pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization precertification certification pre-certification authorize authorizing |
Outpatient Services and/or Ambulatory Surgical Procedures that Require Pre-Authorization | out patients outpatients pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization precertification certification pre-certification authorize authorizing |
Preferred Drug List (PDL) | covered prescriptions formulary drugs medications prefered preferred |
Prescription Request for Authorization | covered prescriptions medications drugs pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization precertification certification pre-certification authorize authorizing |
Provider Demographic Information Change Request Form Guide | how do i we to change update add my our Billing service address? Business? Name? tax id tin w9 w-9 npi instructions help guide guidance |
Provider Demographic Information Change Request Form | how do i we to change update add my our Billing service address? Business? Name? tax id tin w9 w-9 npi |
Provider Manual | instructions help |
Provider Quick Reference Guide | instructions help policy cheet sheet |
Provider Recruitment Form | how do I we sign up |
Radiation Therapy Prior Authorization and Claims Studio Procedure Codes | evi core carecore care pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization precertification certification pre-certification authorize authorizing |
Radiation Therapy Tools and Criteria | evi core carecore care pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization precertification certification pre-certification authorize authorizing |
Radiology Criteria (eviCore healthcare’s evidence-based clinical guidelines) | evi core carecore care pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization precertification certification pre-certification authorize authorizing policy |
Radiology Privileging List | Privileging standards by specialty cpt codes |
Service/Equipment Request for Authorization | pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization precertification certification pre-certification authorize authorizing |
The 90-Day Rx Solution | 90 day covered prescriptions drugs medications |
NYC PICA Drug List (for LPN Members and NYC municipal employees only) | covered prescriptions formulary drugs medications prefered preferred new york city lpn licensed practical nurses welfare fund |
90-Day Rx Solution Maintenance Drug Access Program Waiver Request Form | 90 day maintenance covered prescriptions formulary drugs medications prefered preferred exception prior authuthorization priorauthorization prior-authorization preauthorization pre-authorization |
Utilization Management Master Drug List | pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization outpatients precertification certification pre-certification authorize authorizing um accredo acredo pica nyc employees new york city qty quantity limited express scripts expressscripts evicore evi core cancer oncology split fill step therapy client |
Pharmacist Authority to Administer Vaccines by State | vaccinations vacines vacinations |
Prescription Claims Reimbursement Form | covered prescriptions claims formulary drugs medications prefered preferred new york city lpn licensed practical nurses welfare fund hmo plans retail pharmacies pharmacy |
Transcranial Magnetic Stimulation (TMS) Pre-Authorization | pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization out patients outpatients precertification certification pre-certification authorize authorizing |
PT/OT/ST & Acupuncture Request | pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization precertification certification pre-certification authorize authorizing |
Balance Billing Fee Negotiation Authorization Form | balance billing fee authorization negotiation provider participating provider directory eob |
Care Management Program Quick Reference Guide | evi core carecore care pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization precertification certification pre-certification authorize authorizing quick reference guide frequently asked questions |
Prior Authorization for Intensive Outpatient or Partial Hospitalization Programs | pre prior authorization preauthorization priorauthorization pre-authorization prior-authorization authorize authorizing member assistance concurrent review intensive outpatient program partial hospitalization |
Change Healthcare, Inovalon ABILITY Network FAQs
If I do not have access to the Inovalon ABILITY Network, how do I submit claims? Please inform your clearinghouse that the Benefit Funds now use the Inovalon ABILITY Network. Your clearinghouse should be able to establish a connection to route claims there. If I...
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...
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...
Provider Guides
Quick Reference Guide
Provider Manual
Find answers to your questions about the Benefit Funds’ policies and procedures.
Keep Your Information Up to Date
Review the information we have on record for you, then submit any changes with the Provider Demographic Change Request Form along with a W-9.
Please review the Provider Demographic Change Request Form Guide, which will assist you in completing the form.