COVID-19 vaccines; No cost share for members
Jan. 2022Important Notices
"UPMC Health Plan believes that vaccination is important, helps protect our communities, and saves lives. We advocate that all who can be vaccinated should be vaccinated. Since the first Emergency Use Authorizations were granted, the COVID-19 vaccine has been covered as a preventive service at no cost for UPMC Health Plan members. This applies to all of our comprehensive medical coverage products, including UPMC for Life, UPMC for Life Complete Care, UPMC for You, UPMC for Kids, UPMC Community HealthChoices, and all UPMC commercial group and individual (Pennie/Marketplace) products.
CMS has provided billing guidance and vaccine toolkits that can be found at cms.gov/COVIDvax. As of Jan. 1, 2022, vaccination claims for members with UPMC for Life (Medicare Advantage) should go to UPMC Health Plan, not Medicare Fee-For-Service. To learn more, visit our provider FAQ and Appendix A for more information."
CMS has provided billing guidance and vaccine toolkits that can be found at cms.gov/COVIDvax. As of Jan. 1, 2022, vaccination claims for members with UPMC for Life (Medicare Advantage) should go to UPMC Health Plan, not Medicare Fee-For-Service. To learn more, visit our provider FAQ and Appendix A for more information."
Recent Announcements
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
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
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