Provider Connections Newsletter - Winter 2006

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

1199SEIU

Permit No. 3700

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

WINTER 2006

Your Key to the 1199SEIU Benefit Funds

Helping Fund Members Shed Extra Pounds and Choose Healthy Lifestyles Are Your Patients Confused About Medicare Part D? The Fund Can Help Your Medicare-eligible patients have probably been inundated with information about Medicare Part D. The good news is that most of your 1199SEIU patients already have full prescription coverage. If your 1199SEIU patients are confused about their coverage, the Fund’s Retiree Health Benefits Office can help.

Have our members call us at (646) 473-8770 with any questions.

Remember to Refer in Network!

To avoid unnecessary or expensive out-of-pocket costs, remember to refer to your patients to practitioners within the Network.

A provider directory is available online at www.1199nbf.org, or call us at (646) 473-9200 to request a copy.

As America’s growing obesity problem has become a front-page story, it’s not surprising that our recent member survey found many of our 1199SEIU members wish to lose weight and adopt healthier lifestyles.

1199SEIU Benefit Funds’ Weight Management Program

The polling conducted by the Fund found almost half of the 1199SEIU members we surveyed said that they considered themselves overweight, and 89% of those members want to lose their extra pounds.

GlobalFit Discount Fitness Program

In addition to the care you directly provide, the Fund offers several programs to help members maintain their weight.

If your 1199SEIU patients are interested in making a change, please refer them to the free and discounted programs we provide.

Through our Weight Management program, members meet regularly with a nurse to manage their weight.

Members can call (646) 473-8960 for more information.

Through our partnership with GlobalFit, 1199SEIU members can join local fitness clubs at up to 60% off regular monthly rates. Members can call GlobalFit at (800) 294-1500 or visit GlobalFit on the Internet at www.globalfit.com.

Ongoing Obesity Study The Fund is working with New York-Presbyterian Hospital and the Cornell-Weill Medical Center on a weight-loss study headed by noted obesity specialist Dr. Louis Aronne. The study will help researchers better understand the best weight loss options for our members.

For more information, call our Wellness Department at (646) 473-8960.

Letter From the Executive Director Dear Provider: At the 1199SEIU Benefit Funds, we’ve recently finished polling our members to learn how they view their own health and their relationship with you, our 1199SEIU providers. We are pleased to report that our healthcare providers received very high marks!

Most of the members surveyed said that they have good relationships with their primary care physicians. About 89% said that they know their doctors very or fairly well, and best of all, 97% of those members feel comfortable talking to their doctors about health issues. This confidence in our providers shows that our members are receiving the care that they need, and we appreciate the care you provide.

Our members also reported that one of their biggest health issues is weight control. In this issue, you’ll read about a weight loss study we’re participating in, along with information on 1199SEIU weight management and exercise programs. Since our members have expressed such a great interest in this area, we hope that you will provide them with your own advice and services, as well as refer them to the Fund’s programs. Good advice straight from your own doctor can often be the most powerful medicine!

As our polling shows, our members count on you. We are currently in the process of recredentialing our provider network, so make sure you stay with us! If you have not yet returned your application, please do it as soon as possible. Our Provider Relations representatives will be happy to answer any questions that you may have about the process.

On behalf of our members and the 1199SEIU Benefit Funds, we thank you for the continued quality care you provide to your 1199SEIU patients. We look forward to working with you.

Sincerely, Mitra Behroozi Executive Director 1199SEIU Benefit & Pension Funds

Our Members Count on You We Don’t Want to Lose You! Make Sure To Return Your Recredentialing Application to Remain in our Network

Check Your Claims Status Using WebMD/Emdeon If you’re a provider who submits electronic claims to the Fund through WebMD/Emdeon directly, you can now also access your claims status through the WebMD/Emdeon website at www.emdeon.com.

All you need is a WebMD/Emdeon account and you can expedite your claims status inquiries.

In order to maintain the highest level of care for our members, the Fund is in the process of recredentialing our provider network. Recently, you should have received an application from us. In order to remain in our network, you must complete and submit this application.

For details on how to access your claims contact Emdeon Customer Support at (800) 845-6592.

If you use another vendor, please contact them directly and request an 1199SEIU Benefit Fund claim status (or RO59) report.

We want to thank all of you who have completed and returned your applications for continuing the highquality care you provide to our members.

You will be hearing from us shortly.

In May, the Fund will implement a new claims system that will help us process your claims in the most efficient and timely manner. To avoid any delays, keep an eye out for your new provider identification number in the spring.

If you have any questions, or need assistance filling out your application, don’t hesitate to contact our Provider Relations representatives at (646) 473-7201.

Welcome to our New Director The 1199SEIU Benefit Funds are pleased to welcome Angela Scott, our new Director of Provider Relations. Angela replaces former Director Alicia Ryan, who has been promoted to Special Assistant to the Chief Benefits Officer for Planning and Development. Angela and her staff will continue working closely with our provider network to ensure the highest level of care for our members, and to address any needs or questions you may have.

Stayed Tuned for More Info on Our New Claims System

Intracorp is our New Medical Management Provider For Inpatient Hospital Services and Outpatient Ambulatory Surgery In order to better coordinate our members’ care, the 1199SEIU Benefit Funds have contracted with Intracorp to pre-certify hospital admissions and select outpatient/ambulatory surgical procedures for 199SEIU members.

With Intracorp, you will need to receive pre-certification for certain Outpatient Ambulatory Surgical procedures, including: • • • • • •

Abdominoplasty or Abdominoplasty in combination with hernia repair; Blepharoplasty; Varicose Vein Surgery (Stripping & Ligation); Bone Marrow/Autologous Stem Cell Transplant; Nasal Reconstructive Surgeries; and Reduction Mammoplasty for Macromastia in Women or Gynecomastia in Men.

Pre-certification requirements are regularly updated and are subject to change. For the most current information, please call our Prior Authorization staff at (646) 473-7446. Pre-authorizations are only valid for ninety (90) days from the date they are issued. If your pre-authorization expires, you must contact Intracorp for a new approval. For your convenience, the pre-certification phone number remains the same: (800) 227-9360.

For questions or more information about our Care Management Program including case management for members with complex needs requiring discharge planning and coordination of home care services, don’t hesitate to call us at (646) 473-7393.