Notice: Submit your claims for ACA members
Apr. 2024Important Notices
UPMC Health Plan would like to remind all network providers to submit all outstanding calendar year 2023 claims for ACA members no later than April 15, 2024. HHS requires all issuers to submit their calendar year claims to the EDGE server by April 30 every year in order to provide a more complete and accurate picture of each patient’s health status. Any claims adjudicated after the deadline are not included for EDGE data submission.
Claims can be submitted via the secure portal.
If you have any questions, please contact Provider Services or your physician account executive.
Claims can be submitted via the secure portal.
If you have any questions, please contact Provider Services or your physician account executive.
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
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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