Update to Multiple Procedure Payment Reduction reimbursement

Oct. 2024Important Notices

We previously communicated to both contracted physicians and facilities that UPMC Health Plan will begin applying Multiple Procedure Payment Reduction (MPPR) on certain diagnostic imaging services for Commercial, Medicare and Medicaid lines of business, with contracts based on a percentage of Medicare APC or % billed charges excluded.

There are modifications to this change, as only professional claims will be affected. This implementation will not affect facility claims. Additionally, this application will not include Medicaid line of business claims as previously noted. If you have any questions, please contact your physician account executive or call Provider Services at 1-866-918-1595.


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