Status of High Option Claim

You now have online access to claims and member services information with our new online tool eHealthRecord. With eHealthRecord, you can view claims status and print copies of your EOBs at any time. Also, a year-to-date Health Statement is available to view and print for services rendered beginning January 1, 2007.

To receive information about the status of your claim, members may:

• Check eHealthRecord, our online access to claims information and membership services
• Submit a status inquiry form via the Internet
• Call the Automated Phone System on a touch-tone phone at 1-800/222-APWU (2798) - 7 a.m. to 8 p.m. EST, Monday-Friday
• Call Customer Service at 1-800/222-APWU (2798) - 8:30 a.m. to 8 p.m. EST, Monday-Friday

To Order High Option Claim Forms

To order claim forms, members may:

• Print forms directly from the Internet

High Option Precertification

Inpatient stays must be precertified to avoid a $500 penalty. No precertification is needed if the patient has other health insurance, including Medicare Part A, that is primary to the APWU Health Plan, or if the stay is outside the United States or Puerto Rico. To precertify an admission call 1-800/580-8771 (Minnesota residents call 1-800/451-9597). However, if Medicare Part A is your Primary carrier and your stay exceeds 60 days your hospital stay needs to be precertified.

For emergency or maternity admissions, precertification must take place within 48 hours of the admission, even if the patient has been discharged. If a newborn remains in the hospital past the mother's discharge, these extra days must be precertified. Planned admissions must be precertified at least 48 hours prior to the admission.

Rehabilitative therapy and nursing services must also be precertified. To precertify a hospital stay, call the precertification vendor for your area - click here

MedSolutions, Inc. is responsible for precertification of CAT/CT/MRI/NC/PET Scans. Prior approval of these procedures is required. Failure to obtain required precertification can result in a $100 penalty and/or denial of the claim pending review. The new toll-free number for MedSolutions is 1-888-693-3298, found on the High Option ID Card. Have your provider call prior to these procedures.

High Option Mailing Address for Members

Your PPO network and claims address may have changed for 2008. The claims mailing address is on your 2008 Member ID Card and Sleeve. Be sure to show your ID Card and Sleeve to your doctors and other providers on every visit.

High Option Patient Eligibility/Verification

To verify or determine patient eligibility, call 1-800/222-APWU (2798). The patient eligibility/verification form for submittal over the Internet is under construction.

High Option Nurse Advisory Line

For unlimited, toll-free access to the Nurse Advisory Line - 24 hours a day - seven days a week, dial 1-888-993-0333. You and your covered dependents can talk confidentially, one-on-one with an experienced registered nurse about any health concern. Nurse Advisory Line nurses can help you understand your medical concern or answer your health-related question.

APWU Health Plan High Option Voluntary Disease Management Program

The High Option, through partner CorSolutions, offers a voluntary disease management program to help members avoid unnecessary emergency care or inpatient admissions; and better manage their care when they have certain chronic conditions such as diabetes, coronary artery disease and heart failure.

High Option Coverage Information

To receive information about coverage, members may either:

• Submit a coverage information form via the Internet
• Call the Automated Phone System on a touch-tone phone at 1-800/222-APWU (2798) - 7 a.m. to 8 p.m. EST, Monday-Friday
• Call Customer Service at 1-800/222-APWU (2798) - 8:30 a.m. to 8 p.m. EST, Monday-Friday