HM Medical Clinic

 

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330 West 42nd Street New York, NY 10036-6977 Your Key to the 1199SEIU Benefi t Funds
Cost Savings Initiatives
As you know, the 1199SEIU Benefi t Funds provide our health care workers – your patients - with some of the most comprehensive coverage in the nation. As health care costs escalate, we are constantly looking for ways to protect the benefi ts that they currently enjoy. We've recently instituted several cost-saving measures, and hope that you will help your patients to avoid unnecessary out-of-pocket expenses by following these simple steps:
PARTICIPATING LABS
In order to receive full coverage, 1199SEIU Effective April 1, our pharmacy benefi ts are Benefi t Fund participants must have any lab provided through Medco. You should already work performed by LabCorp. Members have received a copy of our new Preferred may also use their own Member Choice Drug List (PDL). Although this list has expanded Hospital-based lab, Centralized Labs, or from our current PDL, some widely-prescribed Bendiner & Schlesinger. Certain tests, such medications such as Pravachol are no longer as urinalysis and glucose tests, can still be preferred. To help our members avoid out-of- performed at your offi ce. (For a complete pocket costs, please prescribe generic and The Provider Relations Staff:
list check the provider section of our website preferred medications. This list is also available at www.1199nbf.org.) If you are using a on our website.
computerized laboratory routing system, please At Your Service
update your alternate laboratory routing to refer We have also introduced a new maintenance to only LabCorp for 1199SEIU Benefi t Fund drug access program, The 90-Day Rx members. LabCorp can also assist you with Solution. If you are prescribing a maintenance Your Provider Relations Representative is your liaison to setting up an account. For more information, medication for the fi rst time, please write a the Fund. All of our physicians, hospitals, dentists, and contact LabCorp at (800) 788-9091.
prescription for 30 days plus one refi ll, which other providers are assigned a regional representative will be fi lled at a retail pharmacy. Then, give to keep you up-to-date on our policies and procedures the patient a second prescription for a 90-day and let you know of any benefi t changes. Your Our members are now being asked to use supply (with 3 refi lls), if medically appropriate, participating MedFocus radiology facilities to fi ll through mail order or at a local Rite Aid. representative will work with you to navigate our internal or their own Member Choice Hospital-based departments, helping to resolve issues such as contracting radiology departments. For x-rays, please If your patient has previously used the or outstanding claims quickly and effi ciently. For your provide our members with a prescription, maintenance medication, please write a new representative's name, or if you would like to schedule a which they can take to a participating facility. prescription for a 90-day supply (with 3 refi lls). For help locating a convenient facility, or for Members will fi ll these 90-day supplies at Rite visit to your offi ce, call our Provider Relations Department scheduling appointments for MRIs or PET scans, Aid pharmacies in New York or New Jersey or at (646) 473-7222. We're here to help you!
call MedFocus directly at (888) 910-1199.
by mail order.
For routine claim or benefi t questions, please Our representatives are happy to answer any continue to call our general service representatives at of your questions about these changes at (646) 473-9200.
(646) 473-9200 or visit the provider section of our website at www.1199nbf.org.
Letter From the Executive Director
MEMBER ❑
✓ FOR YOUR CONVENIENCE…
New Interactive Voice Response system
I'm pleased to introduce the fi rst issue of for eligibility, effective April 1
Provider Connections, our 1199SEIU Benefi t Your patients and our members – New York's Funds' provider newsletter. We hope that We've put the information you need right at your fi ngertips. this quarterly publication will be a helpful healthcare workers – devote themselves each Beginning April 1, you can quickly verify your 1199SEIU patient's resource for you and your staff.
day to the care of others. Yet, they often neglect their own health. Our 1199SEIU hospital, medical, or vision eligibility twenty-four hours a day, by Our goal this year is to make sure you have providers are critical in helping to keep our calling our new Interactive Voice Response (IVR) system at easy and quick access to the information members healthy, and we encourage our you need. To ensure that all your questions members to help themselves by developing are answered, we've added more staff to our ongoing relationships with their physicians. To access the system, you will need: Provider Relations team. Your designated representative can help you resolve any • Your tax ID number We created the Member Choice program outstanding issues or concerns. To help • Member's social security number and to encourage our members to build these you determine eligibility, we launched an relationships. Member Choice participants • Patient's date of birth Interactive Voice Response System that select a hospital network and a primary will save you valuable time by allowing you care physician (PCP) associated with it. By The IVR system eliminates wait time, and allows you to verify to check member eligibility automatically visiting their PCP regularly, your patients are eligibility for an unlimited number of patients in the same call. through a toll-free phone number. assured of always having a provider familiar For other questions, please call our service representatives at with their medical history. Member Choice (646) 473-9200 or your Provider Relations representative. We're also asking for your continued help hospitals are often the same facilities that our in making sure that our members avoid members work in, making it even simpler for unnecessary out-of-pocket costs. In the past them to access their health benefi ts. months, we've initiated new cost-saving procedures. By using participating labs, KEEP YOUR INFORMATION CURRENT
Although Member Choice is not an HMO, radiology facilities, and our preferred drug we do require patients to stay in their Re-Credentialing Begins This Month
program, your patients should never have network to avoid being balance billed for any out-of-pocket expenses, unless they specialist visits and other services. Each To ensure that we have your most current information, the Fund has are subject to a small co-pay. We ask you to help us by taking the few simple steps Member Choice network has a wide begun re-credentialing many of our participating providers. Keep outlined in this publication.
range of medical services, so please help an eye out for a package of materials, including an application, your Member Choice patients avoid which you must fi ll out and return to the Fund. We look forward to working with you, out-of-pocket costs by referring them and we hope you enjoy Provider within network.
Your package will include a form that lists the information we Connections. Please contact our currently have on fi le for you in our system. Please review it, make Communications Department, at If you are not a Member Choice any necessary corrections, and send us your updates before the [email protected], to let us know
physician and want to see if you are deadline designated on the cover letter. This process helps ensure what you'd like to see in future issues! eligible, please contact your Provider that we have accurate data for our directories, and can process your claims completely and accurately. By Relations representative. Physicians not helping us keep our records current, you are also ensuring that you receive important information about Fund associated with Member Choice networks updates and policy changes. can still become participating providers through our Panel Program. For more Please take a moment to review your information in the Provider Directory posted on our website at information, call our Provider Relations www.1199nbf.org to make sure it's current. If there are any changes, please make sure you contact the Department at (646) 473-7222.
Executive Director Provider Relations Department at (646) 473-7216 to let us know.

Source: http://1199funds.com/wp-content/uploads/2010/11/143.pdf