Resources for healthcare providers
At APWU Health Plan, we partner with healthcare professionals, hospitals, and facilities to improve the health of our members. Thank you for your dedication to protecting the well-being of each patient you serve.
How precertification works with APWU Health Plan
Providers must obtain precertification or prior approval for certain services and procedures:
- If a newborn remains in the hospital past the mother’s discharge, the extra days must be precertified. Planned stays must be precertified at least 48 hours prior to admission.
- Durable medical equipment must be precertified.
- For inpatient mental health and substance use, the physician or hospital must call UHC Behavioral Health Solutions at least two business days before admission of services requiring prior authorization.
- Admissions for inpatient hospital stays, inpatient residential treatment centers, or skilled nursing facilities—and continued care review for long-term injuries/illnesses—require prior approval.
- Radiology services, including CAT/CT, MRI, MRA, and PET scans, require prior approval.
Refer to section 3 the APWU Health Plan federal or postal brochure for detailed precertification guidelines and a complete list of services that require prior approval.
Failure to obtain prior approval of certain procedures will result in a minimum $500 penalty for inpatient hospital (High Option and Consumer Driven Option), $100 for certain outpatient radiology/imaging procedures (High Option only), and/or denial of the claim pending review.
For High Option members, call
For Consumer Driven Option members, call
Call to verify or determine a patient’s eligibility for services:
Medical services
Call the UnitedHealthcare automated phone system 24/7:
1-866-204-8020
Visit the Provider Portal
Call provider services:
1-866-204-8020
7 am – 6 pm ET, Monday – Friday
Dental services
Call APWU Health Plan:
1-800-222-APWU (2798)
8:30 am – 6:30 pm ET, Monday – Friday
Contact APWU Health Plan with questions about a member’s coverage.
Mailing addresses for claims
The current claims mailing information is on the APWU Health Plan member ID card.
High Option
Medical claims
APWU Health Plan is the primary payer
All states and U.S. Virgin Islands
UnitedHealthcare
EDI # 39026
UnitedHealthcare Shared Services
PO Box 30783
Salt Lake City, UT 84130-0783
Submit a claim through the Provider Portal External link
High Option
Secondary medical claims and dental claims
APWU Health Plan is the secondary payer
APWU Health Plan
EDI # 44444
P.O. Box 8660
Elkridge, MD 21075
To get information about a claim or request remittance:
Medical services
Call provider services:
1-866-204-8020
7 am – 6 pm ET, Monday – Friday
Automated phone system is available 24/7
Visit the Provider Portal External link
Call APWU Health Plan:
1-800-222-APWU (2798)
Automated phone system is available 24/7
Dental services
Call APWU Health Plan:
1-800-222-APWU (2798)
8:30 am – 6:30 pm ET, Monday – Friday
Send appeals or general correspondence to the member’s health plan:
High Option clinical appeals
UnitedHealthcare UHSS Appeals
PO Box 64
Huntingdon Valley, PA 19006
Appeal fax: 1-888-615-6584
Consumer Driven Option correspondence
UnitedHealthcare
P.O. Box 740800
Atlanta, GA 30374-0800
Consumer Driven Option appeals
UnitedHealthcare Appeals
P.O. Box 740816
Atlanta, GA 30374-0816
Verify patient eligibility
Call to verify or determine a patient’s eligibility for services:
Medical services
Call the UnitedHealthcare automated phone system 24/7:
1-866-204-8020
Visit the Provider Portal
Call provider services:
1-866-204-8020
7 am – 6 pm ET, Monday – Friday
Dental services
Call APWU Health Plan:
1-800-222-APWU (2798)
8:30 am – 6:30 pm ET, Monday – Friday
Get coverage information
Contact APWU Health Plan with questions about a member’s coverage.
1-800-222-APWU (2798)
8:30 am – 6:30 pm ET, Monday – Friday
Automated phone system is available 24/7
Submit a claim
Mailing addresses for claims
The current claims mailing information is on the APWU Health Plan member ID card.
High Option
Medical claims
APWU Health Plan is the primary payer
All states and U.S. Virgin Islands
UnitedHealthcare
EDI # 39026
UnitedHealthcare Shared Services
PO Box 30783
Salt Lake City, UT 84130-0783
Submit a claim through the Provider Portal External link
High Option
Secondary medical claims and dental claims
APWU Health Plan is the secondary payer
APWU Health Plan
EDI # 44444
P.O. Box 8660
Elkridge, MD 21075
Check claim status
To get information about a claim or request remittance:
Medical services
Call provider services:
1-866-204-8020
7 am – 6 pm ET, Monday – Friday
Automated phone system is available 24/7
Visit the Provider Portal External link
Call APWU Health Plan:
1-800-222-APWU (2798)
Automated phone system is available 24/7
Dental services
Call APWU Health Plan:
1-800-222-APWU (2798)
8:30 am – 6:30 pm ET, Monday – Friday
Mailing addresses
Send appeals or general correspondence to the member’s health plan:
High Option
APWU Health Plan
6514 Meadowridge Rd
Suite 195
Elkridge, MD 21075
Consumer Driven Option correspondence
UnitedHealthcare
P.O. Box 740800
Atlanta, GA 30374-0800
Consumer Driven Option appeals
UnitedHealthcare Appeals
P.O. Box 740816
Atlanta, GA 30374-0816
Join our provider network
Become part of the nationwide network of UnitedHeatlhcare providers who are committed to helping APWU Health Plan members live healthier lives.
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