UPMC for You has been awarded a Medicaid Managed Care Contract for all five Physical HealthChoices zones across the Commonwealth of Pennsylvania

Aug. 2022Important Notices
"UPMC for You has been awarded a Medicaid Managed Care Contract for all five Physical HealthChoices zones across the Commonwealth of Pennsylvania, currently planned to go live1 on Sept. 1, 2022. A comprehensive training is available online for your reference and participation. You can also review a list of frequently asked questions at upmchp.us/ProviderFAQ. Thank you for your continued support of UPMC for You and the great care you provide to our members. We wouldn’t be at more than a half a million members strong and growing without you!

1Go-live implementation dates and communication timelines are subject to change at discretion of the Pennsylvania Department of Human Services."

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