UnitedHealthcare (Empire BlueCross BlueShield) / UnitedHealthcare Appeals Unit fax number

Fax destination details

Department

Appeals Unit (Health Information Release)

Purpose

Release of health information to UnitedHealthcare for claims/appeals processing

Form

Empire Authorization for Release of Health Information — Empire Authorization for Release of Health Information Form

Address

UnitedHealthcare Appeals Unit, P.O. Box 1600, Kingston, NY 12401

Website

Visit organization website

Before you send

• Confirm that this exact department handles your document or request.
• Check the organization website or call its main line for the current fax number.
• Include a cover sheet and any case, member, claim, or form reference required.
• Keep the delivery confirmation with your submission records.

Fill member details, describe the purpose of disclosure, sign and date. If required, have a witness sign for Illinois residents, and return to UnitedHealthcare Appeals Unit at the address below.

Official form instructions are published as a downloadable file on the organization's website.