Your Key to the 1199SEIU Benefit Funds

Spring 2010

Message from the Executive DirectorAs a participating provider, you help us en-sure that our 1199SEIU members have access to high-quality care and services. And part of making sure you can provide that care means keeping you up to date on our Benefit Fund’s programs and policies.

In this edition of Provider Connections, you will learn about important updates to our pre-scription drug program, our new, extended wraparound network for care outside of New York City, our enhanced program for schedul-ing radiology tests and more.

As always, we hope you find this newsletter helpful. Should you have any questions, do not hesitate to contact your personal Provider Representative or our Provider Services Call Center at (646) 473-7160.

Mitra Behroozi

For Care Outside New York City, Refer in the Aetna Signature Administrators (ASA) Network

You may have noticed that your 1199SEIU patients’ Health Benefit ID cards now include information on the Aetna Signature Administrators network. That is because in order to give our 1199SEIU members residing or traveling outside the New York metro area access to the care they need, we have replaced our three former wraparound networks – GHI, Qualcare and Multiplan – with just one, Aetna Signature Administrators.

If you need to refer one of your 1199SEIU patients for care outside of New York City, make sure you’re using a provider that participates in the ASA Network. You can find a complete list on our website at www.1199SEIUFunds.org, by clicking on “Find a Participating Provider.” With close to 800,000 ASA providers nationwide, finding a participating provider should be easy. The Benefit Fund will continue to process these claims directly. 1199SEIU members who need care outside New York City will still have the same benefit plan; they will just use a different network for their care.

As always, when referring your 1199SEIU patients to specialists within New York City, use the Fund’s directly contracted providers. Referring your patients in-network ensures they’re getting the best care without unnecessary out-of-pocket costs.

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Important Prescription Benefit ChangesAs part of our ongoing effort to provide the most clinically effective medications at the lowest possible cost, we periodically update our Preferred Drug List (PDL). The Benefit Fund has made some changes to our PDL. Please keep these in mind when you prescribe medications to your 1199SEIU patients.

New Classes on the Preferred Drug List

As of April 1, the Benefit Funds will add two new drug classes for commonly prescribed medica-tions to our Preferred Drug List. These include antivertigo and antiemetic drugs and otic steroid/antibiotic drugs.

Oral Erectile Dysfunction Medications No Longer Covered

As of February 1, the Fund no longer covers erectile dysfunction medications, including oral Cialis, Levitra, Viagra, brand-name Yocon and generic Yohimbine.

Prescription Cough and Cold Medications No Longer Covered

As of April 1, the Fund will no longer cover prescription cough and cold medications, since similar medications are available over the counter.

Our current Preferred Drug List, as well as details on our prescription program, can be found on our website at www.1199SEIUFunds.org.

To avoid out-of-pocket costs, 1199SEIU members must be

pre-approved for certain high-end radiology tests including

MRIs, MRAs and CT scans. And now our preferred radiology

network, MedFocus, can make that process easier for you and

for your 1199SEIU patients. As part of our ongoing partnership,

MedFocus will coordinate your patients’ testing and help to

schedule them at a convenient participating facility.

You can schedule tests quickly and easily by visiting

www.medfocus.net or by calling MedFocus at (888) 910-1199.

The Benefit Funds’ prescription

drug programs were recently

recognized by the Pharmacy

Benefit Management Institute

(PBMI), as a 2010 Rx Benefit

Innovation Award winner, for

innovative cost containment

strategies that do not shift costs

to 1199SEIU members. To learn

more, go to www.pbmi.com.

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Schedule Radiology Tests through MedFocus

To avoid out-of-pocket costs, 1199SEIU members must be

pre-approved for certain high-end radiology tests including

MRIs, MRAs and CT scans. And now our preferred radiology

network, MedFocus, can make that process easier for you and

for your 1199SEIU patients. As part of our ongoing partnership,

MedFocus will coordinate your patients’ testing and help to

schedule them at a convenient participating facility.

You can schedule tests quickly and easily by visiting

www.medfocus.net or by calling MedFocus at (888) 910-1199.

Reminder! Cardiac pulmonary outpatient rehabilita-

tion services also require prior authorization. To request

authorization, contact our Care Management Department

at (646) 473-7446.

Help Us to Help You: Keep Your Provider Information CurrentCurrent, accurate provider records are the key to getting your claims paid correctly and quickly. Help the Benefit Fund by letting us know of any changes right away.

Updating Your Tax ID NumberIf your Tax ID number changes, you must submit an updated W-9 form to the Benefit Fund as soon as possible. Otherwise, your payments may be delayed. The W-9 form should clearly identify both the Tax ID number and the name of the owner of that specific number. The owner could be you, if you are in private practice, or the hospital or facility you work with.

You must make sure that both the Tax ID number and the name match the information that the IRS has on file. If they do not, the IRS will flag your re-cord, and we may need to suspend your payments

until the issue is resolved. If you have any ques-tions, contact our Provider Services Call Center at (646) 473-7160.

General UpdatesTo make it easier to update your information, we have revised our Provider Demographic Update form. You can download it from our website at www.1199SEIUFunds.org, under “Forms,” and submit it by either mail or fax.

Please note that we can only make updates that are submitted using this form. Update requests that are not submitted on the Provider Demographic Update form will be returned. Once we receive the form, we’ll process your request as soon as pos-sible. You can check our live Provider Directory at www.1199SEIUFunds.org to see if practice-related changes have been updated.

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Electronic Health Records Benefit Your Patients and Your PracticeThe Benefit Funds are always looking for ways to improve our members’ care, and we know that one of the ways providers can help is by using Electronic Health Records (EHRs). In addition to ensuring patient safety and care, EHRs can also help you manage your practice’s billing and office management, making it easier to work with our Funds and with other insurers. If your practice or institution isn’t already using EHRs, we encourage you to make the switch.

Finding the time and resources to switch to a new system is always a challenge, but New York City providers can get support through the Department of Health and Mental Hygiene’s Electronic Health Record Expansion Initiative. Once you apply, the city will provide software at a reasonable cost, and training and support for you and your staff to help get you up and running for a smooth transition. For more information about this New York City initiative, visit www.nyc.gov/pcip, or contact pcip@health.nyc.gov or (212) 442-2043.

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PAIDNew York NY

Permit No. 37001199SEIU Benefit and Pension Funds330 West 42nd StreetNew York NY 10036-6977

ADDRESS SERVICE REQUESTED

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