For providers: How precertification works with an APWU Health Plan

Please refer to the current APWU Health Plan Federal Brochure (RI 71-004) for details about PPO benefits and how they are used, as well as hospital precertification guidelines.

APWU Health Plan precertification vendors

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 stays must be precertified at least 48 hours prior to the admission.

Durable medical equipment, rehabilitative therapy and nursing services also must also be precertified.

All therapies and nursing must be preauthorized by the provider of service.

For inpatient mental health and substance misuse disorder, at least two business days before admission of services requiring prior authorization, the physician or hospital must call UHC Behavioral Health Solutions at 1-800-718-1299.

Some services require prior approval (High Option) and some require pre-notification (Consumer Driven Option):

High Option

All states

Hospital precertification vendor for all states.
For precertification of inpatient hospital stays and continued care review for long-term injuries/illnesses, call 1-800-582-1314.

All states: CAT/CT/MRI/PET scans

Cigna is responsible for precertification of CAT/CT/MRI/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. Cigna’s number is 1-800-582-1314, found on the High Option ID card. The provider must call prior to these procedures.

Consumer Driven Option

Call UnitedHealthcare at 1-800-718-1299.