Provider Connections Newsletter - Spring 2006

Presorted Standard U.S. POSTAGE PAID New York, NY

1199SEIU

Permit No. 3700

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

SPRING 2006

Your Key to the 1199SEIU Benefit Funds

Remind Your Patients:

Emergency Rooms are For Emergencies A recent analysis of our members’ utilization shows

Coordination of Benefits Helps the Fund and Helps Providers!

that 1199SEIU members are using emergency rooms at higher than normal rates, often for nonemergency care. We’re concerned about this trend, because we want to make sure that our

The 1199SEIU Benefit Funds provide our members and

members – your patients – are receiving the care

their families with a comprehensive package of benefits.

they need in the most appropriate setting.

But one of the ways we maximize our benefit dollars is by coordinating coverage between the different insurance

You can also help ensure appropriate emergency room use by following these steps:

The best way for our members to stay healthy

• Make sure that your 1199SEIU patients can reach you when they need to by arranging for a covering physician or live answering service after hours.

• On your voicemail message, advise patients that they should only go to the emergency room in the case of a true emergency.

is through a relationship with a primary care

plans in a member’s household. Accurate coordination

physician whom they know and trust. This

of benefits doesn’t just help the Funds – it also helps

relationship becomes particularly important if an

to ensure that we can process your claims quickly and

accident or illness strikes. As a physician familiar

make sure you get paid promptly. Please remind your

with your patients’ medical histories, you can help

1199SEIU patients to fill out the Funds Coordination of

them decide where to go for treatment – your office,

Benefits questionnaire and to keep it updated.

an urgent care center, or the emergency room.

• Do not refer members to the ER for non-emergency care – instead, ask them to make an appointment with you, or visit one of the Fund’s participating urgent care centers if they need help quickly.

With your help, we can make sure that our members are getting the most out of their benefits.

If your patient is not having a true emergency, but still needs treatment quickly and you are unavailable, refer him or her to one of the Fund’s participating urgent care centers. Call the Fund at (646) 473-9200 for center locations.

Letter From the Executive Director Dear Provider: At the 1199SEIU Benefit Funds, we’re proud to offer our members a broad network of qualified, dedicated providers.

Because we value your participation and the high quality of care you provide to your 1199SEIU patients, we’re always looking for ways to better serve you.

We know that the best way to keep our provider network strong is by meeting your needs, whether by keeping you updated on Fund policies and guidelines or by accurately processing your claims in a timely manner.

That’s why I’m pleased to tell you about the changes we are making to improve our service to you. In this issue of Provider Connections, you’ll read about our new state-of-the-art claims system, which will make submitting your claims to the Fund easier, and about other new policies to streamline our procedures.

We’ve also included information on an important new plan to reduce unnecessary emergency room use among our members.

As always, we appreciate the care you provide to our members, and hope that the administrative changes we’re implementing will help us work together even more effectively.

Yours truly,

Mitra Behroozi Executive Director 1199SEIU Benefit & Pension Funds

New Policies Streamline Services

You Can Now Submit All Claims Electronically Through the Fund’s New Claims System

Pre-Authorization Requirements Reduced for Durable Medical Equipment

Remember - Complete, Accurate Claims Can Be Processed Faster

The Fund no longer requires pre-authorization for covered Durable Medical Equipment that is reimbursed under $250, such as braces, walkers, splints, nebulizers and traction equipment. To pre-authorize equipment over $250, call the Fund at (646) 473-7446.

Check our website at www.1199nbf.org for a full list of services that require pre-authorization.

Vision Vouchers No Longer Required — Call (888) 819-1199 Instead As part of our efforts to streamline services, beginning May 1, your 1199SEIU patients no longer need to present vision vouchers in order to receive eye exams or glasses. To find out if your patient is eligible for vision benefits, simply call our automated voice response system at (888) 819-1199 at any time. You will need your Tax ID number, and your patient’s ID number and date of birth.

If you have any questions, please call our representatives at (646) 473-9200.

In May, the Fund switched to a new state-of-the-art claims system to allow us to better serve our members and our providers. One of the biggest improvements is that we will now be able to accept all claims electronically, even for certain outpatient services that used to require paper submissions.

If you haven’t already been using electronic claims submission, it’s easy to get started. Just go to www.webmd.com. The Fund’s payer number is 13162.

To submit claims for your 1199SEIU patients, you will need to use your new provider ID number.

If you haven’t received your new 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 Provider ID number.

After submitting your claim, make sure you review the submission report to confirm that it was accepted into the system. If you are missing information, such as service codes or your ID number, your claim may not go through.

Need more information? Visit our website at www.1199nbf.org and click on “For Providers.”

The website also has answers to frequently asked questions, and tips for submitting your claims electronically. Or, call our representatives at (646) 473-9200.

Do you have your new Provider ID number?

You must use your new number after May 1 To use the Fund’s new claims system, you will need your updated Provider ID number. Find it online at www.1199nbf.org, or call (646) 473-9200 and ask our representatives.