Provider Connections Newsletter - Fall 2006

Presorted Standard U.S. POSTAGE PAID New York, NY Permit No. 3700

1199SEIU

330 West 42nd Street New York, NY 10036-6977 ALL 2006

Your Key to the 1199SEIU BeneďŹ t Funds

STRONG RELATIONSHIPS WITH 1199SEIU MEMBERS LEAD TO BETTER CARE Dr. Joyce Newman, OB/GYN N participating provider for more than 26 years — and there are a lot of reasons why she enjoys working with her 1199SEIU patients and the 1199SEIU BeneďŹ t Funds.

Help Your 1199SEIU Patients Manage Chronic Illness Through our Wellness Program Did you know that the Fund’s Wellness program is available to help your 1199SEIU patients manage chronic illnesses? If you are treating 1199SEIU patients for hypertension, high cholesterol or diabetes, the Wellness program can work with you and the member to help keep their condition under control. To refer a patient to the Wellness program, call the Fund at (646) 473-8960.

The Fund’s Wellness Department also offers Prenatal and Asthma programs. Call us for more information.

Do We Have Your Most Up-to-Date Information?

If we don’t have your most recent contact information, you may be missing out on important information – or even delaying your claims payments! Take a moment to review the information we have on ďŹ le in our Provider Directory at www.1199nbf.org.

If your address, phone, or other information needs to be updated, contact us at (646) 4737216 or ďŹ ll out the Provider Change form located on the website.

“Unlike other patients who often change doctors whenever they change jobs and insurance carriers, I get to know my 1199SEIU patients and their medical histories,â€? says Dr. Newman. “Most of the time 1199SEIU patients understand their beneďŹ ts and how to use them. If they don’t know, for instance, how to use The 90-Day Rx Solution for long-term prescriptions, I’ll tell them how to. I also help them out by referring them to specialists who I know participate in the Fund’s network.â€?

Dr. Newman also appreciates the overall efďŹ ciency of the Fund’s administration.

²5IF 'VOET BSF FBTZ UP DPNNVOJDBUF XJUI BOE EPOÂľU IBWF UIF ´SFE UBQFÂľ UIBU PUIFS JOTVSFST IBWF Âł Most of all, Dr. Newman believes that trust and familiarity play an important role in care. “Because 1199SEIU patients have the freedom to stay in my care, they take better care of themselves. We know each other and that makes everything better for both of us.â€?

Help Your 1199SEIU Patients Make the Most of Their BeneďŹ ts 1SFTDSJCF NFEJDBUJPOT GSPN UIF NPTU DVSSFOU 1SFGFSSFE %SVH -JTU For the most recent version of the Fund’s Preferred Drug List, call (646) 473-9200 or download the PDL at www.1199nbf.org.

1SFTDSJCF MPOH UFSN NFEJDBUJPOT JO EBZ TVQQMJFT Through The 90-Day Rx Solution, 1199SEIU members order their maintenance medications three months at a time from Medco by Mail, or order and pick them up at a New York or New Jersey Rite Aid. For these medications, make sure to write your 1199SEIU patients a prescription for a 90-day supply with 3 reďŹ lls.

3FGFS 4&*6 QBUJFOUT UP TQFDJBMJTUT JO UIFJS .FNCFS $IPJDF OFUXPSL Refer 1199SEIU patients to physicians within their Member Choice hospital network, or on the Fund’s panel of participating physicians.

Call (646) 473-9200 to check if a specialist is in the Fund’s network.

"SSBOHF GPS B DPWFSJOH QIZTJDJBO PS BOTXFSJOH TFSWJDF BGUFS IPVST Make sure your 1199SEIU patients can reach you or another physician in case of an emergency after hours.

POLICYCORNER

Letter From the Executive Director Dear Provider: Our goal is to work with you to ensure that 1199SEIU members are receiving the highest-quality and most efficient care.

A big part of that goal is improving our service to you.

By now, many of you have had the opportunity to use our most recent service enhancement – our new state-of-the-art claims system, QNXT. We hope you’re noticing an improvement in the speed and accuracy of your claims payments. For any of you who may have experienced a delay in payment during the initial transition, thank you for your understanding. We’ve been hard at work addressing these issues and resolving them as soon as they come up. In fact, 70% of professional claims submitted electronically through QNXT are now being paid in one to three days.

In this issue, you’ll read more about our claims system and other policy changes and benefit information that will allow us to better help you and your 1199SEIU patients. You’ll also read about one of your colleagues in our very first 1199SEIU provider profile. Let us know if you would be willing to share your experiences as an 1199SEIU provider in a future edition.

As always, we appreciate the care you provide to our members. We hope that our service improvements will help us work together even more effectively. If you have any suggestions, please contact our Provider Relations representatives at (646) 473-7222.

Sincerely,

Mitra Behroozi Executive Director 1199SEIU Benefit and Pension Funds

Are You Submitting Claims Electronically?

Apply For Your National Provider Identifier Now!

Our new claims system allows us to accept both institutional (837I) and professional (837P) claims electronically.

Electronic claims submission reduces the time your staff spends on paperwork, and speeds up claim reimbursement.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires health care providers to apply for a federally-assigned National Health Provider Identifier. Providers will need to begin using this NPI on May 23, 2007.

Help us serve you — and your 1199SEIU patients — better. Submit your claims electronically through the easy-to-use Emdeon website. Just go to www.emdeon.com and use the Fund’s payer number: 13162.

The NPI will standardize provider identification nationally and will make it easier for you to identify your health care transactions, including claims, eligibility inquiries, claim status inquiries and referrals.

Although this compliance date may seem far off, the Fund will begin requesting this information from you beginning in October 2006. We encourage you to get a head start and request your NPI now from the U.S. Department of Health and Human Services.

To submit claims for your 1199SEIU patients, you will need to use your Fund provider ID number. If you don’t know your number, you can find it easily by going to www.1199nbf.org and clicking on “For Providers.” Enter your existing tax identification number to look up your new number. After submitting your claims, make sure you check your submission report to confirm that all the necessary information was included.

To request your NPI electronically, go to http://nppes.cms.hhs.gov. Or, to download a paper application, go to www.cms.hhs.gov.

Please note that the NPI will not replace your existing Fund ID number. After October 2006, you will need to use both numbers for claims and other Fund transactions.

1199SEIU Members Allowed Only 12 Chiropractic Visits Per Year Beginning January 1, 2007, the Fund will be strictly enforcing our policy of only 12 chiropractic visits per year. Any additional visits must be pre-authorized through the Fund’s CareReview program. Keep an eye out for more details through the fall.

Pharmacy Changes: Omeprazole and Nexium Are the Only Covered PPIs Beginning September 1, 2006, Nexium and omeprazole will be the only proton pump inhibitors covered by the Fund. If you have 1199SEIU patients currently using other PPIs, such as Prevacid or Prilosec, please provide them with a new prescription. As a reminder, if you feel your 1199SEIU patient needs this medication for more than 90 days, you will need to obtain prior approval from the Fund.

Nassau Retirees Join 1199SEIU HIP VIP Plan Some Patients May Need Assistance Changing Physicians As mandated in the last Collective Bargaining Agreement, Medicare-eligible 1199SEIU retirees in Nassau County (like those in the five boroughs of New York City) will receive their Fund retiree health benefits through the 1199SEIU HIP VIP/Medicare Plan beginning on October 1. Since many of our providers are already in HIP’s network, we anticipate that most Nassau retirees will not have to change physicians. However, if you are not in HIP’s network, we encourage you to help any affected 1199SEIU patients find a new provider in-network by calling HIP’s dedicated line for 1199SEIU retirees at (877) HIP-1199. These members will also receive a new identification card to use for medical services.