ACA Risk Adjustment Claims Submission Announcement

Jan. 2026Important Notices

Notice: Submit your claims for ACA members

This is a reminder that all network providers must submit outstanding calendar year (CY) 2025 claims for ACA members (Platinum, Gold, Silver, and Bronze plans) no later than April 1, 2026. The U.S. Department of Health and Human Services requires issuers to submit their CY claims to the EDGE server by April 30 every year to provide a complete and accurate picture of each patient’s health status.

Claims adjudicated after the deadline will not be included for EDGE data submission.

You can submit claims through Provider OnLine at upmchealthplan.com/providers/medical. If you have any questions about this matter, please contact Provider Services or your physician account executive.

Recent Announcements

UPMC Dental Advantage celebrates 15-years of growth

From pilot program to now serving all product lines
Jan. 2026What's New

Register for the Oral Health in Your Pediatric Office CME - accredited webinar

Please join us for a live, CME-accredited webinar on Wednesday, March 11 from noon to 1 p.m. that will provide an overview of oral health in your pediatric office. Providers with a(n) MD/DO, PA, CRNP, RN, or LPN may also apply for topical fluoride certification after completion of this course.
Jan. 2026Education/Webinars

CME Webinar: Compassionate Care for the Fasting Patient During Ramadan

Please join us for a live, CME-accredited webinar on Tuesday, Feb. 3, that will educate clinicians on providing compassionate and culturally sensitive care to fasting patients during Ramadan.
Jan. 2026Education/Webinars