Your Key to the 1199SEIU Benefi t Funds

1199SEIU

SPRING 2006

330 West 42nd Street

New York, NY 10036-6977

Presorted Standard

U.S. POSTAGE PAID

New York, NY

Permit No. 3700

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

• 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.

• 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 benefi ts.

The 1199SEIU Benefi t Funds provide our members and their families with a comprehensive package of benefi ts. But one of the ways we maximize our benefi t dollars is by coordinating coverage between the different insurance plans in a member’s household. Accurate coordination of benefi ts doesn’t just help the Funds – it also helps to ensure that we can process your claims quickly and make sure you get paid promptly. Please remind your 1199SEIU patients to fi ll out the Funds Coordination of Benefi ts questionnaire and to keep it updated.

A recent analysis of our members’ utilization shows that 1199SEIU members are using emergency rooms at higher than normal rates, often for non-emergency care. We’re concerned about this trend, because we want to make sure that our members – your patients – are receiving the care they need in the most appropriate setting.

The best way for our members to stay healthy is through a relationship with a primary care physician whom they know and trust. This relationship becomes particularly important if an accident or illness strikes. As a physician familiar with your patients’ medical histories, you can help them decide where to go for treatment – your offi ce, an urgent care center, or the emergency room.

Coordination of Benefi ts Helps the Fund and Helps Providers!

Remind Your Patients:

Emergency Rooms are For Emergencies

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.

Dear Provider:

At the 1199SEIU Benefi t Funds, we’re proud to offer our members a broad network of qualifi ed, 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.

Letter From the Executive Director

Yours truly,

Mitra BehrooziExecutive Director

1199SEIU Benefi t & Pension Funds

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 fi nd it easily by going to www.1199nbf.org and clicking on “For Providers.” Enter your existing Tax Identifi cation number to look up your new Provider ID number.

After submitting your claim, make sure you review the submission report to confi rm 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.

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.

Do you have your new Provider ID number?

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 fi nd out if your patient is eligible for vision benefi ts, 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.

Pre-Authorization Requirements Reduced for Durable Medical Equipment

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.

You Can Now Submit All Claims Electronically Through the Fund’s New Claims System Remember - Complete, Accurate Claims Can Be Processed Faster

New Policies Streamline Services