For providers: How precertification works with APWU Health Plan

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.

UHC Behavioral Health Solutions

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

For High Option members, call 1-866-569-2064.
For Consumer Driven Option members, call 1-800-718-1299.

Prior approval and pre-notification

Some High Option services require prior approval, while some Consumer Driven Option services require pre-notification.

High Option

Hospital precertification vendor for all states

Precertification of inpatient hospital stays and continued care review for long-term injuries/illnesses is required.

Call UnitedHealthcare at 1-866-569-2064.

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. The provider must call UnitedHealthcare prior to these procedures.

Call UnitedHealthcare at 1-866-569-2064.

Consumer Driven Option

For pre-notification, call UnitedHealthcare at 1-800-718-1299.