Announcements
Featured Announcements
Important announcement: UPMC Health Plan retires MP.PA.147
This communication is in regards to UPMC Health Plan Policy MP.PA.147 – Diagnostic and Surveillance Colonoscopy, 18 Years Old and Older. UPMC Health Plan previously communicated that the prior authorization requirement under this policy would be paused until Sept. 1, 2025. However, policy MP.PA.147 has been retired, and this policy will no longer be implemented or active.Aug. 2025Important Notices
Recent Announcements
Understanding available resources for substance misuse and addiction
Information available on the internet can be overwhelming when searching on the topic of substance misuse and addiction. UPMC Health Plan has a dedicated webpage containing information and links to treatment service options, harm reduction services, and other supports. The webpage includes local, state, and national resources to help streamline the search process for members and their families who may be experiencing challenges related to substance misuse and addiction, and for providers who may be looking for information on how to best support their patients.Aug. 2025Important Notices
The importance of PRD forms for complex patients and staying updated on changes
Personal representative designation (PRD) forms are critical to the care process for patients and providers alike. Not only do PRDs support accurate, efficient, and compliant patient care—they also streamline administrative processes.Aug. 2025Important Notices
CMS expands Medicare Advantage RADV audits to all eligible plans
On May 21, 2025, the Centers for Medicare & Medicaid Services (CMS) announced a substantial expansion of its Risk Adjustment Data Validation (RADV) audit program for Medicare Advantage plans.Aug. 2025What's New
Feedback sought on your experience with UPMC Health Plan
You may be randomly selected to participate in a 2025 Press Ganey provider satisfaction survey that will begin this month.Aug. 2025Important Notices
Prescription for Wellness ~ Leveraging Insurance Carrier Resources to Optimize Patient Engagement Outcomes!
Prescription for Wellness is a nationally recognized, Six Sigma-developed best practice system that provides a convenient and effective way for providers to prescribe resources and support offered by UPMC Health Plan to their patients who are UPMC Health Plan members.Aug. 2025Education/Webinars
Voluntary nationwide recall: Sucralfate (Nostrum – July)
Nostrum Laboratories, Inc. is recalling all lots of Sucralfate Tablets USP 1 gram. Sucralfate is used for the prevention and treatment of certain stomach ulcers.Jul. 2025Pharmacy Updates
Receive consultations to better support the behavioral health needs of child and adolescent patients
The Telephonic Psychiatric Consultation Service Program (TiPS) is a Pennsylvania HealthChoices program that gives primary care providers access to free, on-demand consultations with child and adolescent psychiatrists, typically within 30 minutes. It is available to providers of children and adolescents who have Pennsylvania Medicaid, Children’s Health Insurance Program, or UPMC Health Plan commercial insurance.Jul. 2025What's New
Feedback sought on your experience with UPMC Health Plan
You may be invited to participate in a 2025 Press Ganey provider satisfaction survey, which will begin next month. This survey will be given to a random sampling of in-network primary care providers.Jul. 2025Important Notices
Important Notice Regarding Prior Authorizations for MP.PA.147
UPMC Health Plan previously communicated that prior authorizations would be required under policy Diagnostic and Surveillance Colonoscopy, 18 Years Old and Older – MP.PA.147 effective June 1, 2025. However, the prior authorization requirement will be paused until Sept. 1, 2025.Jul. 2025Important Notices
Clinical documentation required for hip, knee, and shoulder prior authorizations
As you know, UPMC Health Plan requires certain clinical documentation/notes in support of a request for prior authorization for hip, knee, and shoulder procedures in accordance with its established policies and procedures, in addition to CMS requirements that medical record documentation must support the medical necessity of the services requested.Jul. 2025Important Notices
Featured Announcements
Important announcement: UPMC Health Plan retires MP.PA.147
This communication is in regards to UPMC Health Plan Policy MP.PA.147 – Diagnostic and Surveillance Colonoscopy, 18 Years Old and Older. UPMC Health Plan previously communicated that the prior authorization requirement under this policy would be paused until Sept. 1, 2025. However, policy MP.PA.147 has been retired, and this policy will no longer be implemented or active.Aug. 2025Important Notices
Recent Announcements
Understanding available resources for substance misuse and addiction
Information available on the internet can be overwhelming when searching on the topic of substance misuse and addiction. UPMC Health Plan has a dedicated webpage containing information and links to treatment service options, harm reduction services, and other supports. The webpage includes local, state, and national resources to help streamline the search process for members and their families who may be experiencing challenges related to substance misuse and addiction, and for providers who may be looking for information on how to best support their patients.Aug. 2025Important Notices
The importance of PRD forms for complex patients and staying updated on changes
Personal representative designation (PRD) forms are critical to the care process for patients and providers alike. Not only do PRDs support accurate, efficient, and compliant patient care—they also streamline administrative processes.Aug. 2025Important Notices
CMS expands Medicare Advantage RADV audits to all eligible plans
On May 21, 2025, the Centers for Medicare & Medicaid Services (CMS) announced a substantial expansion of its Risk Adjustment Data Validation (RADV) audit program for Medicare Advantage plans.Aug. 2025What's New
Feedback sought on your experience with UPMC Health Plan
You may be randomly selected to participate in a 2025 Press Ganey provider satisfaction survey that will begin this month.Aug. 2025Important Notices
Prescription for Wellness ~ Leveraging Insurance Carrier Resources to Optimize Patient Engagement Outcomes!
Prescription for Wellness is a nationally recognized, Six Sigma-developed best practice system that provides a convenient and effective way for providers to prescribe resources and support offered by UPMC Health Plan to their patients who are UPMC Health Plan members.Aug. 2025Education/Webinars
Voluntary nationwide recall: Sucralfate (Nostrum – July)
Nostrum Laboratories, Inc. is recalling all lots of Sucralfate Tablets USP 1 gram. Sucralfate is used for the prevention and treatment of certain stomach ulcers.Jul. 2025Pharmacy Updates
Receive consultations to better support the behavioral health needs of child and adolescent patients
The Telephonic Psychiatric Consultation Service Program (TiPS) is a Pennsylvania HealthChoices program that gives primary care providers access to free, on-demand consultations with child and adolescent psychiatrists, typically within 30 minutes. It is available to providers of children and adolescents who have Pennsylvania Medicaid, Children’s Health Insurance Program, or UPMC Health Plan commercial insurance.Jul. 2025What's New
Feedback sought on your experience with UPMC Health Plan
You may be invited to participate in a 2025 Press Ganey provider satisfaction survey, which will begin next month. This survey will be given to a random sampling of in-network primary care providers.Jul. 2025Important Notices
Important Notice Regarding Prior Authorizations for MP.PA.147
UPMC Health Plan previously communicated that prior authorizations would be required under policy Diagnostic and Surveillance Colonoscopy, 18 Years Old and Older – MP.PA.147 effective June 1, 2025. However, the prior authorization requirement will be paused until Sept. 1, 2025.Jul. 2025Important Notices
Clinical documentation required for hip, knee, and shoulder prior authorizations
As you know, UPMC Health Plan requires certain clinical documentation/notes in support of a request for prior authorization for hip, knee, and shoulder procedures in accordance with its established policies and procedures, in addition to CMS requirements that medical record documentation must support the medical necessity of the services requested.Jul. 2025Important Notices