Your Key to the 1199SEIU Benefit Funds
Winter/Spring 2012 At the 1199SEIU Benefit Funds, we continually work to strengthen our partnership with you, our healthcare providers, in order to offer our members an extensive, quality network. One of the ways we do that is by keeping you up to date on policy changes and innovations at the Funds, which ensures that you are equipped with the tools you need to provide our members with the medical care they deserve. In this issue of Provider Connections, we encourage you to refer your 1199SEIU patients to our Health Coaching Service and 24-Hour Nurse Helpline to give them the added support they need to lose weight, quit smoking or better manage their chronic conditions.We have included important updates to our Preferred Drug List (PDL), specialty care pharmacy and maintenance drug program, The 90-Day Rx Solution. Finally, we also remind you to submit your electronic claims using the new HIPAAcompliant format to avoid delayed payments. As always, we value our relationship with you and hope that you find this newsletter helpful. You can also find our newsletter, PDL and program information online at www.1199SEIUFunds.org. If you ever have any questions, please don’t hesitate to contact a representative in our Provider Relations Call Center at (646) 473-7160.
Mitra Behroozi, Executive Director 1199SEIU Benefit and Pension Funds
Message from the
Executive Director At the 1199SEIU Benefit Funds, we continually work to strengthen our partnership with you, our healthcare providers, in order to offer our members an extensive, quality network.
Remember to Bill Electronically in 5010 Format The Centers for Medicare & Medicaid Services (CMS) now require providers that file claims electronically to use the new version of the standard electronic Health Insurance Portability and Accountability Act (HIPAA) transaction version, 5010. In order to prevent delayed payments and make sure your transaction is processed correctly the first time, please submit your claims using the updated 5010 standards and current procedure codes. Any claims submitted using the 4010 transaction standards or outdated procedure codes will be deemed non-compliant and rejected, resulting in lost time and delayed reimbursement. For more information, visit www.cms.gov and search “5010.” If you need further assistance, please call our Provider Relations Call Center at (646) 473-7160.
Remember to Refer Your 1199SEIU Patients to Providers Within Our Network
Refer Your 1199SEIU Patients to Our Health Coaching Service Whether your 1199SEIU patients are trying to lose weight, quit smoking, manage their diabetes or improve their heart health, they have an added resource in our 1199SEIU Health Coaching Service and 24-Hour Nurse Helpline.You can refer your patients to our health coaching service for telephonic weight management and smoking cessation programs, and professionally trained health coaches will support the care you provide with extra one-on-one coaching. A recent study in The New England Journal of Medicine found that more than one-third of obese patients whose physicians referred them to a coaching service to adopt a healthier lifestyle had sustained weight loss over a two-year period. The Johns Hopkins University researchers reported that of 390 participants, 34.9 percent of those who supplemented their physician’s care with telephone health coaching services lost at least 5 percent of their body weight.Working together, we can help some of our most at-risk members make powerful, positive changes in their lives. For members trying to give up tobacco, our coaches can offer free nicotine replacement patches or gum, improving their chances of giving up cigarettes for good.Your patients can also use their Fund’s prescription drug benefits to try medications to support their smoking-cessation goals. The health coaching service can provide ongoing support to your treatment plan for your 1199SEIU patients diagnosed with, or at risk for, diabetes and heart disease. And even if your 1199SEIU patients don’t want long-term coaching support, they can still call our 24-Hour Nurse Helpline for answers to their health-related questions 24 hours a day, 7 days a week.
If your 1199SEIU patients need coaching support or access to a 24-hour nurse, encourage them to call (866) 935-1199.
Whether your patient needs to see a specialist or receive lab, radiology or other ancillary services, be sure you send them to a provider within our network to ensure they get the care they need from credentialed providers with no out-of-pocket costs. A list of participating providers, searchable by specialty, location or hospital network, as well as an updated directory of preferred labs, is available at www.1199SEIUFunds.org. Before ordering any test, procedure or treatment for your 1199SEIU patients, please verify that the service is covered by the 1199SEIU Benefit Fund and is not considered experimental or investigational, as the Fund does not cover these services.
Fund Partners with CAQH to Simplify Your Application Process If your facility, institution or office is already among the more than 980,000 providers that belong to the Council for Affordable Quality Healthcare (CAQH), you may no longer need to fill out a provider application form for the 1199SEIU Benefit Funds. We’ve partnered with CAQH in order to streamline the application process, and we are now able to access the most current provider information through the CAQH system, including credentialing and recredentialing data. For more information, or if you have questions about the provider application process, call a representative in our Provider Relations Call Center at (646) 473-7160.
Two New Drugs Added to Our Preferred Drug List Effective January 1, 2012, the Benefit Funds added two new brand-name drugs to our Preferred Drug List (PDL).The drugs, which are used to treat asthma and chronic obstructive pulmonary disease (COPD) and are listed on our PDL in the Respiratory category, are: • •
Pulmicort FlexHaler Symbicort
Our clinical pharmacists constantly review and revise our PDL to ensure that the most cost- and clinically effective medications are available to our members. Before prescribing medication for your 1199SEIU patients, please consult the most up-to-date version of the PDL at www.1199SEIUFunds.org to ensure that they’re covered.
Additions to Our Specialty Care Pharmacy Accredo, the Benefit Fund’s specialty care pharmacy, has added 12 new drugs to its list of available medications. For your 1199SEIU patients who need medications that require refrigeration or other special handling, the specialty care pharmacy is the surest and safest way to fill their prescriptions.The medications are delivered directly to your patient, and your prescription orders are handled by simply calling an Accredo representative at (800) 987-4904 and providing him or her with the patient’s 1199SEIU Member ID number. The new specialty care medications are: • Adcetris* • Eylea • Fondaparinux (generic Arixtra) • Gammaked* • Jakafi • Nulojix • Sylatron • Victrelis • Xalkori* • Yervoy* • Zelboraf* • Zytiga* * Requires prior authorization A complete list of specialty care drugs covered by the Benefit Funds is available at www.1199SEIUFunds.org.
HIV/AIDS Drugs Now Part of The 90-Day Rx Solution Mail Order Program All of your 1199SEIU patients who take long-term medications to manage chronic conditions fill their prescriptions through the Benefit Funds’ 90-Day Rx Solution, which delivers a 90-day supply of medicine directly to the patient’s home address or to a local Rite-Aid pharmacy. Effective January 1, 2012, your 1199SEIU patients taking medications for HIV/AIDS also need to fill their prescriptions through our mail order program. Please remember to write three-month prescriptions to your 1199SEIU patients being treated for HIV/AIDS. After an initial 30-day prescription and one refill, these patients will face unnecessary out-of-pocket costs if they do not fill their prescriptions using The 90-Day Rx Solution.
1199SEIU Benefit and Pension Funds 330 West 42nd Street New York, NY 10036-6977
Non-Profit U.S. Postage PAID New York, NY Permit No. 3700
ADDRESS SERVICE REQUESTED