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  • Provider Demographic Information Change Request Form1199seiu Funds

Get Provider Demographic Information Change Request Form1199seiu Funds

Raphic Information Change Request Form Please type or print legibly to avoid processing delays or complete online. Participating provider Non-participating provider Current Provider Information PROVIDER NAME EMAIL ADDRESS(ES) (GROUP OR INDIVIDUAL) S.

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The 1199SEIU Funds began with the Local 1199 Benefit Plan. Formed in 1945, its goal was to provide basic health, disability and life insurance benefits to just 300 New York City retail drugstore workers with employer-paid contributions. In 1948, the Benefit Fund became self-insured and self-administered.

If you need to see us in person, you can avoid wait times by scheduling an appointment with a Member Services Representative. Make an appointment or call (646) 473-9200. You may also email us at OutreachAssistance@1199Funds.org.

To check 1199SEIU patient eligibility, benefit and claim status information, please visit our provider portal at .NaviNet.net, or call (888) 819-1199 to be connected to our 24-hour automated claims and eligibility system.

Simply call (888) 819-1199 and enter your tax ID number, the member's ID number and date of birth. You can check an unlimited number of patients in one call.

Call our Provider Call Center at (646) 473-7160 if you have questions, or email Providers@1199Funds.org.

1199SEIU National Benefit Fund Members are generally eligible for benefits after they have been working for a contributing employer for 90 days or more, and the employer has made contributions to the Fund for 30 days or more. If you have questions about your eligibility, call the Fund at (646) 473-9200.

CLAIMS SUBMISSION Submit the completed form by fax to (646) 473-7088, by email to MedicalRecon@1199Funds. org or by mail to 1199SEIU Benefit Funds, Medical Claims Reconsideration, PO Box 717, New York, NY 10108-0717.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232