1199SEIU Funds

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:
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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.