1199SEIU Benefit Funds: Recredentialing Guide for Providers

12/08/2025

1199SEIU: Provider Network Recredentialing

As of November 27, 2025, the 1199SEIU Benefit Funds requires recredentialing of all in-network providers every three years to verify qualifications and ensure compliance with standards. This process uses the Council for Affordable Quality Healthcare (CAQH) ProView system, with validation by CredSimple, an NCQA-certified organization. Providers must update profiles to avoid disruptions in participation status.

Process Overview

Recredentialing confirms ongoing eligibility based on initial criteria plus additional reviews for utilization patterns, member complaints, and changes since last credentialing. It applies to practitioners, facilities, and ancillary providers. Separate from recredentialing, providers must attest to profile accuracy every 90-120 days.

Requirements and Documents

Update the CAQH application via https://proview.caqh.org. Key actions:

Re-attest to all profile information, including practice addresses.
Complete five-year work history.
Submit: Current malpractice policy face sheet ($1M/$3M minimum), W-9 for new billing locations.
Grant CAQH access to the Funds for verification.

Non-registered providers register at https://proview.caqh.org/PR/Registration.

All initial criteria (e.g., licenses, board certification, no excessive claims) must remain met.

Submission and Review

Submit updates through CAQH ProView, designating the Funds as an authorized plan. The Provider Relations Department reviews applications, verifies via primary sources, and forwards to the Credentialing Committee (monthly meetings, chaired by the Chief Medical Officer). Providers may request info review (excluding sensitive items). Delegated credentialing requires annual audits.

Timelines and Compliance

No fixed deadline for current cycle; complete promptly to maintain status. Network adequacy checks precede full process (30-45 days response). Fraudulent info leads to immediate termination. Notify Funds of changes during the process.

Guidance

Contact Provider Relations—Network Management at Providers@1199Funds.org or (646) 473-7160. Fax: (646) 473-7213.

Full details: Recredentialing Page (https://www.1199seiubenefits.org/providers/recredentialing/).

Provider Manual (https://www.1199seiubenefits.org/providers/manual/participating-providers-and-networks/). Verify eligibility via Availity or (800) 456-2369.