Timeframe for Claims Submission and Guide 1199SEIU insurance

Timeframe for Claims Submission

Providers must submit clean claims within 90 days of the date of services or the date of discharge for inpatient services. The 1199SEIU Benefit Funds may deny claims submitted more than one year after the date of service or discharge unless proof of timely filing can be established.


CLAIMS AND REIMBURSEMENT

The 1199SEIU Benefit Funds strive to pay clean, electronic claims within 20 days of receipt and clean, non-electronic claims within 45 days of receipt. A “clean claim” means either a properly completed UB04, CMS-I500 or 2006 ADA Form that is submitted for payment promptly and which includes all information needed to process the claim, including coordination of benefits information required by the 1199SEIU Benefit Funds.

All claims should include the Member ID number, the 1199SEIU Benefit Funds’ Payer Identification Number (see Section 9.3), the Plan Provider ID number (see Section 9.4) and the National Provider Identifier (see Section 9.5).




Claims Submission

Providers must submit claims electronically, unless the claim requires attachments or documentation that cannot be accommodated  electronically. Electronic claims submission is a secure vehicle to transmit claims information to the 1199SEIU Benefit Funds.

The 1199SEIU Benefit Funds accept professional service (837P) and inpatient and outpatient hospital claims (837I) in an electronic format through several clearinghouses, including Emdeon (formerly WebMD), MD On-Line, Capario (formerly MedAvant) and RelayHealth.  The 1199SEIU Benefit Funds do not currently accept dental claims electronically. To establish an account with Emdeon, call (800) 845-6592 or check their website at www.Emdeon.com.

To establish an account with MD On-Line, call (888) 499-5465 or visit www.1199MDOL.com.

To establish an account with Capario, call (800) 792-5256 or visit www.Capario.com.

We also accept both institutional and professional EDI claims from RelayHealth (www.RelayHealth.com).

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