Announcements

1/2021What You Need to Know About Coronavirus

UPMC Health Plan is actively monitoring the COVID-19 pandemic—including the vaccine. As you well know, this is a rapidly evolving situation, and we will continue to provide timely updates to our network providers regarding issues that affect you and our member-patients.

The COVID-19 vaccine has arrived at UPMC hospitals. Consistent with public health guidance, UPMC is first giving the vaccine to at-risk healthcare workers and residents of long-term care facilities. This staged delivery and prioritization for high-risk groups is being coordinated with the Pennsylvania Department of Health.

Your patients will likely have many questions for you regarding the vaccine. Please direct them to the UPMC website and the UPMC Health Plan COVID-19 website for the most up-to-date information.

Read our provider FAQ.

This information is current as of Dec. 30, 2020. Providers should check back daily for updates.

1/2021Review Appendix A – COVID-19 Special Coverage and Payment Policy

Review our Appendix A - COVID-19 Special Coverage and Payment Policy for the latest policy updates.

1/2021UPMC for Life Removed Network Limitations for HMO Premier Rx Plans in 2021

Many of our current HMO Premier Rx plans were provider-specific plans (PSPs). That means these plans offer a limited network of participating providers that members can use for their care.

Effective Jan. 1, 2021, PSPs will only apply to members who live in Berks County and are enrolled in the HMO Rx, HMO Premier Rx, or PPO Rx Enhanced plan. All other UPMC for Life members will have access to the full UPMC for Life provider network!

This change is noted on the UPMC for Life HMO Premier Rx member ID cards. For all members (excluding those who live in Berks County and are enrolled in the plans listed above), the network name will read as UPMC Medicare Network. There will no longer be a Premier Medicare Network or UPMC/Excela Medicare Network.

Participating UPMC for Life providers can be in our online searchable provider directory. Feel free to share this link with your patients.

1/2021Recall: Anagrelide (Torrent)

Torrent Pharmaceuticals is recalling one lot of Anagrelide 1 mg capsules because of a dissolving quality issue found during routine quality testing. Anagrelide is used to treat a blood cell disorder called thrombocythemia. Read the full text of the Anagrelide (Torrent) recall.

1/2021Recall: Sildenafil (AvKare)

AvKare is recalling one lot of Sildenafil 100 mg tablets due to mispackaging issue with another medication, Trazodone 100 mg tablets. Sildenafil 100 mg is used to for the treatment of erectile dysfunction. Read the full text of the Sildenafil (AvKare) recall.

12/2020Chlamydia Screening: A Call to Action Webinar Recording Available to Replay Now!

Watch Harold C. Wiesenfeld, MD, CM, host a webinar on chlamydia screenings. During the hour-long discussion we identified the local epidemiology of chlamydia infections, described the health consequences, and reviewed strategies to overcome barriers to screening. We also identified best practices to improve chlamydia screenings and presented information on the current regional chlamydia screening trends. You can also earn continuing medical education (CME) credits for watching the webinar.

Watch the webinar recording.

12/2020HMS Provider Education Webinars Are Now Available

HMS has engaged with UPMC Health Plan to perform Automatic Implantable Cardioverter Defibrillator (AICD), Place of Service (POS), Inpatient Rehabilitation Facility (IRF), and Readmission reviews. Providers can access pre-recorded training webinars on AICD, POS, IRF, and Readmission clinical claim reviews. These training webinars will help ensure that providers understand the audit and medical record submission process and will provide additional instructions on the best way to collaborate and communicate with HMS. HMS has created a dedicated email to answer questions related to the new programs or review process. You can email ProviderEdu@hms.com through Dec. 31, 2020. When using this email, please include “UPMC Health Plan” in the subject line. Any questions after Dec. 31, 2020, should be directed to the Provider Relations call center at 1-866-875-1749.

Recorded presentations:

UPMC Readmissions
Provider Outreach and Education_ UPMC Readmissions - Webinar (12.2020) on Vimeo UPMC AICD
Provider Outreach and Education_ UPMC AICD - Webinar (12.2020) on Vimeo

UPMC IRF
Provider Outreach and Education - UPMC IRF - Webinar (12.2020) on Vimeo

UPMC POS
Provider Education Webinar- Place of Service Review (122020)1 on Vimeo

12/2020Introducing RxWell

Prescription-strength health

Over the past few months, you’ve likely become familiar with our Brain Manager mobile app—and it’s here to stay. However, Brain Manager is becoming RxWell.

RxWell will still offer techniques to help your patients build skills to support them in living their best life. This new-and-improved version builds on the successes of Brain Manager’s anxiety and depression programs and introduces a new track that deals with stress management—plus new features make using RxWell even easier for your patients. Of course, RxWell will still help patients solve problems, practice meditation techniques (e.g., deep breathing), and challenge their thought patterns so they are better equipped to self-manage these conditions.

• Personalized tracks
  Patients will choose from three evidence-based programs—anxiety, stress, or depression—based on their needs.* RxWell will teach them mindfulness-based and cognitive behavioral therapy techniques that are tailored to their personal journeys.
• Digital support from a health coach
  All users get access to the help and support of a UPMC Health Plan health coach who can assist them. Health coaches are there for users as they work through any challenges they encounter along the way—directly in the app.
• Tracked progress
  Regular check-ins allow patients to identify patterns in their behavior, mood, and emotions over time.
• No cost to patients
  We believe that good mental health improves physical well-being, but cost is often a prohibitive factor for patients. That’s why RxWell is offered to all UPMC Health Plan members at no cost.

Help your patients take the first step toward improving their mental health. Let them know they can download RxWell today from the Apple App Store or Google Play! All they need to get started is their UPMC Health Plan member ID.

Providers who use the UPMC version of Epic as their EMR can prescribe RxWell to patients right from the Epic Dashboard. When you prescribe RxWell for patients, you can monitor their use of the app. Learn more about prescribing RxWell through Epic.

Additional RxWell provider resources

*RxWell is not a crisis service. It is a tool that your patients age 18 and older can download and use at their convenience.

12/2020Good Health, Better World

UPMC Health Plan has launched a podcast that will explore how our society affects our health. Factors like access to employment, housing, and transportation are commonly called the social determinants of health. Hosted by Dr. Ellen Beckjord, AVP, Population Health and Clinical Transformation at UPMC Health Plan, the episodes feature conversations with community leaders, government officials, and UPMC Health Plan experts.

To access episodes, visit the Good Health, Better World podcast.

Date available	The conversation	Guests
Episode #1: 12/08/20	Improving health as a community	Fr. Paul Abernathy, CEO, Neighborhood Resilience Project Ray Prushnok, AVP Programs and Executive Director, UPMC Center for Social Impact
Episode #2: 12/15/20	Connecting to the social safety net	Julie DeSeyn, Chief Program and Policy Officer, United Way of Southwestern Pennsylvania Dan Swayze, DrPH, MBA, MEMS, VP Community Services, UPMC Health Plan and Director of Operations, UPMC Innovative Home Care Solutions
Episode #3: 12/22/20	Better jobs, better health	Sec. Teresa Miller, Pennsylvania Department of Human Services Earl Buford, CEO, Partner4Work Dan LaVallee, Director, UPMC Center for Social Impact
Episode #4: 1/4/21	How a home helps your health	Everett McClevan, CEO Community Human Services John Lovelace, President, Government Programs, UPMC Health Plan

12/2020Chlamydia Screening: A Call to Action Webinar Recording Available to Replay Now!

Watch Harold C. Wiesenfeld, MD, CM, host a webinar on chlamydia screenings. During the hour-long discussion we identified the local epidemiology of chlamydia infections, described the health consequences, and reviewed strategies to overcome barriers to screening. We also identified best practices to improve chlamydia screenings and presented information on the current regional chlamydia screening trends. You can also earn continuing medical education (CME) credits for watching the webinar.

Watch the webinar recording.

11/2020UPMC Health Plan Provider Services Holiday Hours

We would like to let you know that our Provider Services center will be closed on Thanksgiving, Christmas, and New Years Day.

11/2020UPMC Health Plan Implementing InterQual Connect to Automate Prior Authorization Reviews

UPMC Health Plan is excited to announce that we will implement InterQual Connect® on Feb. 1, 2021, to automate medical prior authorization reviews for codes not currently managed by HealthHelp. Medical prior authorization requirements and criteria are unchanged. InterQual Connect has been customized to align with UPMC Health Plan's Medical Prior Authorization policies.

When InterQual Connect is implemented, providers will enter prior authorization requests through Provider OnLine and the requests will be launched to InterQual Connect. If the criteria are met, the provider will receive an authorization in real time. If the request does not meet criteria, the authorization request will be forwarded to the Utilization Management Team for review just as it is today.

What providers can expect:

• Before you begin to enter the request information, you will have the ability to query the system to determine if a prior auth for the CPT code is required.
• Clinical information will be entered and can be uploaded into InterQual Connect.
• You can review the status of an authorization through Provider OnLine in the Auth Entry/Inquiry tab.
• HealthHelp and pharmacy prior authorization requirements are unaffected and will continue to follow the current submission and review processes.

Important note: The requirement for prior authorizations for Home Health Services, which had previously been suspended, will be reimplemented on Feb. 1, 2021, with additional details to follow.

Contact your physician account executive for help with the process or if you do not have access to the internet. You can also reach out to Provider Services at 1-866-918-1595 with any other questions. Training and supporting materials will be available on Provider OnLine in the upcoming weeks.

11/2020Recall: Paroex Chlorhexidine Gluconate Oral Rinse USP, 0.12% (Sunstar – Oct.)

Sunstar Americas Inc. (SAI) is recalling Paroex® Chlorhexidine Gluconate Oral Rinse USP, 0.12% bearing an expiration date from 6/30/22 to 9/30/22 due to possible contamination with bacteria. This medication is used for the treatment of gingivitis (a gum disease). Read the full text of the Paroex Chlorhexidine Gluconate Oral Rinse recall.

11/2020Recall: Metformin ER (Nostrum)

Nostrum Laboratories Inc. is recalling multiple lots of Metformin Hydrochloride Extended Release Tablets, USP, 500 mg and 750 mg because of an impurity found in the products above levels established by the FDA. Metformin HCl ER tablets are used to improved blood sugar in adults with type 2 diabetes. Read the full text of the Metformin ER (Nostrum) recall.

11/2020Partners Program Gaps in Care (CGMA) Notification Center

We want you to know that the new Partners Program Gaps in Care (CGMA) capability, which instantly notifies you of important care gap and member roster status change events, is now available. These notifications will include letting you know when care gap submissions or member roster change requests submitted by you have been returned to you for further action. For more information, review our training video or FAQ document.

11/2020SNP Plan Name Change

UPMC for Life has updated our HMO SNP plan name, UPMC for Life Dual, to UPMC for Life Complete Care (HMO SNP). Our new name reflects the whole-person care and security we provide to all of our members! Members will get the same great benefits and access to high-quality care that they have always enjoyed. We will mail current members about the change to their plan name in October. The name change will take effect Jan, 1, 2021. Sample ID cards are available for your review.

11/2020Pulmonary Rehabilitation Locations for Your COPD Population

Many treatment options are available for patients with COPD; pulmonary rehabilitation is one strategy that may be ideal for your patients. Studies show that early use of pulmonary rehabilitation after hospitalization for a COPD exacerbation is associated with increased survival at one year compared with initiation after 90 days or not at all.¹ This often-underutilized program can reduce patients’ symptoms, increase their ability to participate in daily activities, and improve their quality of life.

UPMC contracts with many pulmonary rehabilitation locations throughout our service area. Once you’ve referred your patient, they can schedule an appointment at the location that is most convenient for them.

You can find a complete list of UPMC Health Plan in-network pulmonary rehabilitation sites at upmchp.us/PRadultsites.

For more information about UPMC’s pulmonary rehabilitation program, visit upmc.com/services/pulmonology/our-services/respiratory/services/pulmonary-rehab.

Source:
Lindenauer PK, Stefan MS, Pekow PS, et al. Association between initiation of pulmonary rehabilitation after hospitalization for COPD and 1-year survival among Medicare beneficiaries. JAMA 2020;323(18):1813-1823.

10/2020Human Papillomavirus Diseases, Vaccination, and Your Healthcare Provider Superpower

Learn about the importance of timely HPV immunizations and how to confidently recommend them. Please view Dr. Todd Wolynn’s recorded HPV presentation, Human Papillomavirus Diseases, Vaccination, and Your Healthcare Provider Superpower. Dr. Wolynn is a pediatrician and CEO at Kids Plus Pediatrics in Pittsburgh, Pennsylvania.

This presentation offers an opportunity to review epidemiology and outcomes of HPV infection, including trends in HPV-related cancers. Learn about the importance of HPV vaccination for cancer prevention; possible changes to HPV vaccine recommendations; and recent uptake, safety, and impact data. Earn Continuing Medical Education (CME) credits.*

*In support of improving patient care, the University of Pittsburgh is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the health care team.

Physician (CME)
The University of Pittsburgh designates this enduring material activity for a maximum of 1.0 AMA PRA Category 1 Credits.* Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nursing (CNE)
The maximum number of hours awarded for this Continuing Nursing Education activity is 1.0 contact hours.

10/2020Recall: Metformin (Marksans Pharma - Oct.)

Marksans Pharma Limited, India, is recalling multiple lots of metformin hydrochloride extended-release tablets, USP, 500 and 750 mg, because of an impurity found in the products above levels established by the FDA. Metformin HCl ER tablets are used to improve blood sugar in adults with type 2 diabetes. Read the full text of the Marksans Pharma metformin recall.

10/2020Notice: ONAF Submission Updates

Beginning November 14, Optum OB Care will be making system updates to their platform. Learn more about the Optum OB Care updates.

10/2020Recall: NP Thyroid (Acella – Sept)

Acella Pharmaceuticals LLC is recalling one lot of 15 mg (Lot # M327E19-1) and one lot of 120 mg (Lot #M328F19-3) NP Thyroid®, Thyroid Tablets, USP [levothyroxine (T4) and liothyronine (T3)] due to it being subpotent (lower than normal or acceptable potency). Read the full text of the NP Thyroid recall.

10/2020UPMC for Life updates for 2021

Get the latest on UPMC for Life plan improvements, changes, and more—including:

• Medicare Staying in Touch events
• Prescription drug changes
• Extra benefits and services
• SNP plan name change
• Maximum out-of-pocket changes

Learn more in October's Provider Partner Update.

9/2020Recall: Nature Thyroid and WP Thyroid

RLC Labs, Inc. is recalling 483 lots of Nature-Thyroid® and WP Thyroid® due to it being subpotent (lower than normal or acceptable potency). Nature-Thyroid and WP Thyroid are used for hypothyroidism (underactive thyroid). Read the full text of the Nature Thyroid and WP Thyroid recall.

9/2020Mandatory Training for Medicare SNP Providers

The Centers for Medicare and Medicaid Services (CMS) require all Medicare Special Needs Plan (SNP) providers to complete the Model of Care Training. The Model of Care describes the structure and process by which health care services are delivered to SNP members.

For your convenience, UPMC Health Plan has developed a brief online training module on the Model of Care for our SNP product, UPMC for Life Complete Care (HMO-SNP) (formerly known as UPMC for Life Dual).

To complete the training, go to upmchp.us/snp-moc-2020. You will need your tax identification number to sign up.

If you have any questions or concerns, feel free to contact your physician account executive or call Provider Services at 1-866-918-1595.

Thank you for your continued support and the care you provide for our members!

9/2020CGMA Announcement

UPMC Health Plan has encountered an unexpected delay processing blood pressure claims for the Partners Program Gaps in Care (CGMA) system. Please be assured we have received all blood pressure claims submitted this year through this system and are prioritizing a resolution to accurately close the gap. All users will receive a notification when the issue has been corrected. At that time, appropriate reporting and status will be accessible within CGMA.

We apologize for the inconvenience and appreciate your patience.

9/2020Update on Member Cost Share for Colorectal Cancer Screenings

UPMC Health Plan is making colorectal cancer (CRC) screening easier and more accessible for our members. We are changing our billing procedures for UPMC Health Plan members who complete a fecal test with a positive result necessitating a follow-up colonoscopy. Learn about the adjustments in our billing guide and provider newsletter.

9/2020New Prior Authorization Forms for Continuous Glucose Monitors available for All Lines of Business

Continuous Glucose Monitors

9/2020Coverage of Telehealth Well-Child Visits

The COVID-19 pandemic has led to unprecedented social distancing measures. These guidelines have encouraged people to avoid leaving their homes except for essentials like groceries or urgent medical care. As such, many parents are postponing pediatric well-visits.

As indicated by the American Academy of Pediatrics (AAP) and Bright Futures periodicity schedule, UPMC Health Plan recommends that children covered by UPMC for Kids, UPMC for You, and Commercial plans see their PCP in person for annual well-visits. However, in light of current social distancing guidelines, UPMC Health Plan will consider well-child visits done via telehealth and conducted in a way that optimizes care delivery as valid well-child visits.

UPMC Health Plan will cover telehealth well-child visits for pediatric members of UPMC for Kids, UPMC for You, and Commercial plans in accordance with AAP and Bright Futures recommendations. Coverage varies based on the need for in-person well-child testing.

UPMC Health Plan has developed billing guides to assist providers in administering and billing compliant telehealth well-child visits:

EPSDT Telehealth Billing Guide
Commercial and UPMC for Kids Billing Guide

If you have any questions please contact your physician account executive or call Provider Services at 1-866-918-1595.

Note for all billing guidance for EPSDT: The EP modifier must still be placed first for EPSDT billing consideration.

Remember, these steps are not intended to supersede your preferred methods of care delivery and the provider is responsible for the appropriate billing of services.

9/2020Recall: Metformin ER (Bayshore Pharmaceuticals LLC)

Bayshore Pharmaceuticals LLC is recalling one lot of metformin HCL ER tablets, USP, 500 mg, and one lot of metformin HCL ER tablets, USP, 750 mg, because of an impurity found in the products above levels established by the FDA. Read the full text of the Bayshore Pharmaceuticals LLC Metformin ER recall.

8/2020AnywhereCare Virtual Visit

UPMC AnywhereCare, UPMC Health Plan’s telemedicine tool, offers a convenient and easy way for patients to get a medical evaluation from home or the office if they are having common conditions like a cold or sore throat, or think they are experiencing COVID-19 symptoms. Patients can have a virtual visit with a UPMC provider right from their smartphone, tablet, or computer in minutes.* Children up to age 17 can be seen by pediatric providers from UPMC Children’s Hospital of Pittsburgh.** UPMC Health Plan Members pay a $0 visit copay until Sept. 30, 2020.^† AnywhereCare is available 24/7 and providers can send prescriptions to the patient’s preferred pharmacy, if needed. UPMC AnywhereCare can provide general medical advice, plus treat the following conditions and more:

• Bronchitis and coughs
• Cold and flu symptoms
• Diarrhea
• Pink eye
• Rashes
• Seasonal allergies
• Sinus infections
• Tick bites
• Vaginal yeast infections

Patients can sign up for UPMC AnywhereCare by visiting anywherecare.upmc.com or downloading the UPMC AnywhereCare app from the Apple App Store or Google Play Store.

*UPMC Health Plan members located in Pennsylvania at the time of virtual visit may select a UPMC-employed provider or a provider from Online Care Network II P.C. (OCN), subject to availability and discretion of the provider. Members located outside of Pennsylvania will receive service from OCN. OCN is not an affiliate of UPMC.

**UPMC Children’s AnywhereCare is available only to patients who are in Pennsylvania. In order for a child to have a UPMC Children’s AnywhereCare visit, the child’s parent or legal guardian must be with the child during the video portion of the visit, and the child and parent or legal guardian must be in Pennsylvania during the visit. Members located outside of Pennsylvania at the time of service may select the standard UPMC AnywhereCare module and will receive care from a provider employed or contracted by Online Care Network II P.C. (OCN) at the discretion of the provider. OCN is not an affiliate of UPMC.

†Limitations may apply for members of self-funded (ASO) plans that have opted out of coverage.

8/2020LAST CHANCE! Reminder to Encourage Members to Get Preventive Screenings

We would like to remind you of our preventive screening incentive program for your patients enrolled in a UPMC for Life plan. Members who meet the eligible HEDIS criteria and complete certain preventive services between January 1, 2020, and December 31, 2020, can receive a UPMC for Life Visa® Prepaid Card.* This card can be used everywhere that Visa debit cards are accepted. View a flier that explains the program and who qualifies. We hope you will encourage eligible UPMC for Life members to participate!

*Card is issued by MetaBank®, member FDIC, pursuant to a license from Visa USA Inc. No cash access or recurring payments. Can be used everywhere Visa debit cards are accepted. Card valid for up to six months, funds do not expire and may be available after card expiration date, fees may apply. Card terms and conditions apply.

8/2020Recall: DDAVP (Ferring–August)

Ferring Pharmaceuticals US is recalling all lots of DDAVP® Nasal Spray 10 mcg/0.1 mL, Desmopressin Acetate Nasal Spray 10 mcg/0.1 mL, and STIMATE® Nasal Spray 1.5 mg/mL because these lots are superpotent (above normal or acceptable potency). These products are used to control fluids and treat some blood disorders. Read the full text of the DDAVP (Ferring - August) recall.

8/2020August 26: Join a Live Presentation on HPV Diseases and Vaccination

Pediatrician Todd Wolynn will discuss HPV and related diseases and recommendations on HPV vaccines from the Advisory Committee on Immunization Practices. Learn about the importance of timely HPV immunizations and earn CME* credits.

Tune in to Dr. Wolynn's presentation on Wednesday, August 26 from noon to 1 p.m. Register today at https://upmchp.us/hpv.

*This activity is approved for the following credit: AMA PRA Category 1 Credit™, and ANCC. Other health care professionals will receive a certificate of attendance confirming the number of contact hours commensurate with the extent of participation in this activity.

8/2020UPMC Health Plan Now Offers a Pain Management Consultation Line for Physicians Across Pennsylvania Treating Our Members

Provider pain management consultation letter

Provider pain management consultation flier

8/2020Recall: Daptomycin (Mylan—July)

Mylan is recalling one lot (# 7605112) of daptomycin for injection, 500 mg/vial, due to particulate matter being found in one single-dose vial. Read the full text of the Mylan Daptomycin recall.

7/2020Provider Relief Fund Application Process

The U.S. Department of Health and Human Services (HHS), through the Provider Relief Fund (PRF), is distributing $15 billion to eligible Medicaid, CHIP, and dental providers. If you are a provider who is interested in learning about the application process for the PRF, you can visit www.hhs.gov/coronavirus/cares-act-provider-relief-fund for the latest information and updates.

7/2020Recall: Metformin ER (Lupin2) (Lupin Pharmaceuticals Inc.)

Lupin Pharmaceuticals Inc. is recalling all lots of Metformin Hydrochloride Extended Release Tablets, USP, 500 mg and 1000 mg, because of an impurity found in the products above levels established by the FDA. Read the full text of the Lupin Pharmaceuticals Inc. recall.

7/2020Recall: Metformin ER (Granules Pharmaceuticals Inc.)

Granules Pharmaceuticals Inc. is recalling 12 lots of Metformin HCL ER Tablets, USP, 750 mg, because of an impurity found in the products above levels established by the FDA. Read the full text of the Granules Pharmaceuticals Metformin ER recall.

7/2020UPMC Announces Patient-centered Initiative to Reduce Out-of-Pocket Prescription Drug Costs for UPMC Health Plan Members

Read the full press release.

7/2020EPSDT Periodicity Schedule Update

The EPSDT Periodicity Schedule has been updated to reflect the changes made by DHS Bulletin 99-20-04 on May 26, 2020.

7/2020Reminder to Encourage Members to Get Preventive Screenings

We would like to remind you of our preventive screening incentive program for your patients enrolled in a UPMC for Life plan. Members who meet the eligible HEDIS criteria and complete certain preventive services between January 1, 2020, and December 31, 2020, can receive a UPMC for Life Visa® Prepaid Card.* This card can be used everywhere that Visa debit cards are accepted. View a flier that explains the program and who qualifies.

We hope you will encourage eligible UPMC for Life members to participate!

*Card is issued by MetaBank®, member FDIC, pursuant to a license from Visa USA Inc. No cash access or recurring payments. Can be used everywhere Visa debit cards are accepted. Card valid for up to six months, funds do not expire and may be available after card expiration date, fees may apply. Card terms and conditions apply.

6/2020Update Your Profile With Demographic Information About Providers in Your Office

You can now give racial, ethnic, and linguistic information about providers in your office on the Provider Change Form (under the Update Race/Ethnicity and Language Information section). While providing this information is voluntary, it can help accommodate increasingly diverse patient populations who may face disparities in health care because of language and other related barriers. For example, giving patients the option to connect with providers who speak their first language can help them feel comfortable and make more informed decisions about their care.^* Language and language service information will still be available through UPMC Health Plan’s provider directory. However, demographic information will only be made available to individual members upon request.

*Mullins CD, Blatt L. Health disparities: A barrier to high-quality care. Am J Health Syst Pharm. 2005 September 15; 62(18):1873–18.doi: 10.2146/ajhp050064

6/2020Dr. Schuster's and Dr. Hurford's Viewpoint: Addressing the Mental Health Impact of COVID-19

Dr. Schuster and Dr. Hurford recently co-authored an article on mental health and how it has been affected during the COVID-19 pandemic. Read the full article on Dr. Schuster's and Dr Hurford's discussion.

6/2020Telehealth Well-Child Visits

UPMC Health Plan covers telehealth well-child visits for pediatric members of UPMC for Kids, UPMC for You, and commercial plans in accordance with American Academy of Pediatrics and Bright Futures recommendations. Coverage varies based on the need for in-person well-child testing. Further coverage guidance will be provided in the coming weeks to help providers make determinations regarding appropriate types of visits.

6/2020Recall: Metformin ER (Marksans Pharma)

Marksans Pharma Limited, India, is recalling all lots of metformin hydrochloride extended-release tablets, USP, 500 mg, because of an impurity found in the products above acceptable levels established by the FDA. Read the full text of the Marksans Pharma Metformin ER recall.

6/2020Recall: Metformin ER (Teva)

Teva Pharmaceuticals USA Inc. is recalling 14 lots of metformin hydrochloride extended-release tablets, USP, 500 mg and 750 mg, because of an impurity found in the products above the acceptable levels established by the FDA. Read the full text of the Teva Pharmaceuticals Metformin ER recall.

6/2020Equitable access to patient-centered, high-quality health coverage and health care

We are aware that on June 12, 2020, HHS announced modifications to the 2016 rule implementing Section 1557 of the Affordable Care Act that, among other things, remove protections against discrimination in health coverage based on sex stereotyping and gender identity. We at the UPMC Insurance Services Division believe that every individual deserves to have equitable access to patient-centered, high-quality health coverage and health care that is provided with dignity and respect. Our commitment to nondiscrimination will not change based on the weakening of Section 1557 or the narrowing of sex- and gender-related regulatory protections. We will continue in our ongoing efforts to establish, maintain, and reinforce dignity, respect, and equality for all of our members. Toward this end, we will continue to apply coverage terms and member cost sharing equally and without regard for gender identity or gender expression. The rule will not change our existing coverage policies for gender-affirming procedures and related health services for our insurance members. In short, the UPMC Insurance Services Division will continue to do everything it can to ensure that all members continue to have access to the care and coverage they need.

6/2020UPMC Health Plan Extends Members' No-cost Access to Telehealth Services

Until September 30, 2020, UPMC Health Plan will waive all member cost sharing—including deductibles and copayments— for covered services provided via telehealth with in-network providers.* This also applies to telehealth services from UPMC AnywhereCare, FQHCs, and RHCs. UPMC Health Plan requests that POS 02, modifier 95, or both be included with all telehealth visits for any UPMC Health Plan member claim to ensure appropriate processing of $0 member cost sharing.

This extension until September 30, 2020, applies to individuals enrolled in UPMC Health Plan’s fully-insured commercial group coverage, individual ACA Marketplace plans, UPMC for Kids, and our UPMC for Life Medicare Advantage plans.

UPMC Health Plan’s technical requirements and information on covered telehealth services can be found in UPMC Health Plan policy MP.148, which is available online through our Policies and Procedures Manual. Temporary changes to our telehealth coverage policy can be found in Appendix A – COVID-19 Special Coverage and Payment Policy.

*While almost all of our individual and group plans include extensive telehealth benefits, some ASO/self-funded employer plans do not cover telehealth services. Coverage of some services may be limited following the end of the national COVID-19 emergency period.

6/2020Recall: Metformin ER (Apotex)

Apotex Corp. is recalling all lots of metformin hydrochloride extended-release tablets, USP, 500 mg, because of an impurity found in the products above the acceptable levels established by the FDA. Read the full text of the Metformin ER (Apotex) recall.

6/2020Appendix A – COVID-19 Special Coverage and Payment Policy Updates

UPMC Health Plan had temporarily extended the timely filing requirement for administrative and medical necessity provider appeals. The timely filing requirement was extended from within 30 business days of the initial denial notification to within 60 business days of the initial denial for the dates of 3/15/20 – 6/15/20. This appeals extension will end on 6/15/20. For coverage decisions made on or after 6/15/20, standard filing timelines will apply.

6/2020Recall: Metformin ER (Amneal)

Amneal Pharmaceuticals LLC is recalling all lots of metformin hydrochloride extended-release tablets, USP, 500 mg and 750 mg, because of an impurity found in the products above the acceptable levels established by the FDA. Read the full text of the Metformin ER (Amneal) recall.

6/2020Recall: NP Thyroid

Acella Pharmaceuticals LLC is recalling several lots of NP Thyroid, which have been deemed superpotent. Read the full text of the recall.

6/2020CGMA Announcement

There is a new feature in the CGMA that will allow record transfer uploads to support the removal of members from the member roster. The documents can be uploaded under the current “Verify Patient Affiliation” option by selecting “Patient is seeing a Primary Care Physician at a different office,” then choosing “YES” under "Medical Record Transfer Documentation." The documentation must include Authorization for Release of Protected Health Information, including the signature of the patient or parent/legal guardian, if the patient is younger than age 18. The name of the provider to whom the Protected Health Information is released should also be documented. Please see the FAQ within the CGMA on the provider portal documents and forms "Provider Training" section for additional information.

6/2020UPMC Health Plan Extends Members’ No-cost Access to Telehealth Services

Read the full details in our latest press release. UPMC Health Plan requests that POS 02 or modifier 95 (with any other appropriate POS) be included with all telehealth visits for any UPMC Health Plan member claim to ensure appropriate processing of $0 member cost sharing.

6/2020Medical Policy Pulled: MP.159

MP.159 was recently pulled for further consideration by multiple stakeholders that may necessitate policy refinement. More information will be posted as it becomes available.

5/2020Recommendations for Completing Medicare Annual Wellness Visits Via Telehealth

UPMC Health Plan is prioritizing the health of our Medicare members through the Medicare annual wellness visit (AWV). The AWV is integral to our members’ health because it can be used as an opportunity for gap closure. Conveniently for Medicare members, AWVs can be conducted through telehealth.

We have developed a complimentary AWV booklet and webinar to assist providers in administering and billing compliant AWVs:

• AWV Telehealth Webinar
• AWV Toolkit booklet

Remember, these steps are not intended to supersede your preferred methods and the provider is responsible for the appropriate billing of services. You are not required to use our resource material, but it is intended to support accurate Medicare AWV documentation.

Additionally, we recognize that some Medicare and SNP members may not have video capability. In these cases, AWVs can be conducted via audio. Per CMS guidelines, an HCC screening can only be captured using synchronous audio and video. As a best practice, UPMC Health Plan is recommending that telehealth AWVs be conducted via real-time synchronous audio and video. If the AWV is audio-only, be sure to schedule an in-person AWV to capture HCCs and other screenings such as BMI, blood pressure, and HbA1C.

5/2020IMPORTANT: ALL NETWORK PROVIDERS

UPMC Health Plan is enhancing its existing claims editing procedure to improve claims processing accuracy. The effective date was previously communicated as April 1, 2020, but due to COVID-19 the go-live date was changed to June 15, 2020. Beginning June 15, 2020, UPMC Health Plan will closely review claims that have been billed with certain modifiers. These modifiers are sometimes used incorrectly to override unbundling edits. Specifically, modifier 25 should only be used to indicate separately identifiable E/M services, and modifiers 59, XE, XS, XP, and XU should only be used to indicate that a procedure or service is distinct or independent from other services performed on the same day. To align with industry standard coding guidelines and modifier descriptions, UPMC Health Plan’s review will use nationally sourced guidelines to determine the appropriateness of a modifier used to bypass code edits. This enhanced editing process will provide claim adjudication that more closely aligns with coding guidelines.

5/2020Update: SEP for those affected by COVID-19

On Tuesday, May 5, 2020, CMS released a memo announcing that there is a Special Enrollment Period (SEP) available nationwide to individuals who have been affected by COVID-19. To qualify for this special enrollment period the below criteria must be met.

An SEP exists for individuals affected by a major disaster who were unable to and did not make an election during another valid election period. This includes both enrollment and disenrollment elections.

Individuals will be considered “affected” and eligible for this SEP if they:

• Reside, or resided at the start of the incident period, in an area for which FEMA has declared an emergency or a major disaster and has designated affected counties as being eligible to apply for individual or public level assistance;
• Had another valid election period at the time of the incident period; and
• Did not make an election during that other valid election period.

In addition, the SEP is available to those individuals who do not live in the affected areas but rely on help making health care decisions from friends or family members who live in the affected areas.

The SEP is available from the start of the incident (March 1) and for four full calendar months after the start of the incident period (June 30).

Individuals will be given one opportunity to make that missed election and will not be expected to provide proof that they were affected by the pandemic-related emergency.

Read the full announcement from CMS.

5/2020Encourage your UPMC for Life patients to complete their annual wellness visit from home

Through telehealth video visits, your patients can complete an annual wellness visit and talk with a doctor or provider face-to-face to get medical care and advice.

Until June 15, all UPMC for Life members have a $0 copay for telehealth services. Plus, if they complete an annual wellness visit by December 31, they will receive a $20 UPMC for Life Visa® Prepaid Card to use anywhere Visa debit cards are accepted.

Once your patients complete their annual wellness visit through telehealth and you submit a claim, it may take up to 32 days for them to receive their reward in the mail. You can help your patients get their reward sooner by submitting your claims promptly!

If you have any questions about telehealth or the preventive care rewards program, please contact your physician account executive or call Provider Services at 1-866-918-1595.

Card is issued by MetaBank®, N.A., Member FDIC, pursuant to a license from Visa U.S.A. Inc. No cash access or recurring payments. Can be used everywhere Visa debit cards are accepted. Card valid for up to 6 months, funds do not expire and may be available after card expiration date, fees may apply. Card terms and conditions apply.

5/2020Recall: Ketorolac Tromethamine Injection

Fresenius Kabi USA LLC is recalling numerous lot numbers of Ketorolac Tromethamine Injection due to the presence of particulate matter found in sample vials. Read the full text of the recall.

5/2020Recall: Tetracycline Capsules

Avet Pharmaceuticals Inc. is recalling numerous lot numbers of Tetracycline HCl Capsules, 250 and 500 mg, because of low amounts of tetracycline. Read the full text of the recall.

5/2020Recall: Nizatidine Oral Solution

Amneal Pharmaceuticals LLC is recalling three lots of Nizatidine Oral Solution, 15 mg/mL (75 mg/5 mL), because of an impurity found in the products above acceptable levels established by the FDA. Read the full text of the recall.

4/2020Most Recent FQHC/RHC Telehealth Guidance

We know you have many questions regarding telehealth services available to UPMC Health Plan members during the COVID-19 public health emergency (PHE). Federally Qualified Health Centers, Look-A-Like, and Rural Health Clinics can read more about our telehealth guidance.

4/2020Announcing UPMC Children's AnywhereCare

UPMC Health Plan’s telemedicine service—UPMC AnywhereCare—has expanded to offer care to children of all ages.

With UPMC Children’s AnywhereCare, children up to age 17 can have Virtual Urgent Care visits 24/7 with UPMC Children’s Hospital of Pittsburgh providers over live video. All your patients need is a smartphone, tablet, or computer.

UPMC Health Plan will waive all cost-sharing—including copays and deductibles—until June 15, 2020, for UPMC Health Plan members who use this service.*

UPMC Children’s AnywhereCare allows children to get medical attention quickly and safely from their home. Providers can screen children who may have been exposed to COVID-19, and they can provide treatment for these and other conditions commonly treated by a pediatrician or urgent care provider:

• Bronchitis and coughs
• Cold and flu symptoms
• Diarrhea
• Pink eye
• Rashes
• Sinus infections
• Tick bites
• Urinary tract infections

UPMC Children’s AnywhereCare is available only to patients who are in Pennsylvania.** Patients who are 3 or older can also use the standard UPMC AnywhereCare service if they need medical assistance.

We hope you will tell your patients or their parents about this convenient care option. Remember, UPMC Health Plan members can have no-cost visits through June 15. Patients who are not UPMC Health Plan members can still use UPMC Children’s AnywhereCare when they are in Pennsylvania; however, they will be charged $59 for their visits.

Patients or their parents can sign up for UPMC Children’s AnywhereCare by visiting anywherecare.upmc.com or downloading the app from the Apple App Store or Google Play.

*While almost all of our individual and group plans include extensive telehealth benefits, some ASO/self-funded employer plans do not cover telehealth services.

**UPMC Children’s AnywhereCare is available only to patients who are in Pennsylvania. In order for a child to have a UPMC Children’s AnywhereCare visit, the child’s parent or legal guardian must be with the child during the video portion of the visit, and the child and parent or legal guardian must be in Pennsylvania during the visit. If you are located outside of Pennsylvania at the time of service, you may select the standard UPMC AnywhereCare module and you will receive care from a provider employed or contracted by Online Care Network II PC (“OCN”) at the discretion of the provider. OCN is not an affiliate of UPMC.

4/2020Market withdrawal: Ranitidine (Zantac) products

The U.S. Food and Drug Administration (FDA) has requested that all manufacturers of ranitidine products withdraw the drug from the U.S. market because of an impurity found in the products above levels established by the FDA. The impurity is a chemical called N-Nitroso dimethylamine (NDMA) and it is a probable human carcinogen. Read the full text of the withdrawal.

4/2020Staying in Touch

UPMC Health Plan’s Staying in Touch events can help your patients stay connected and informed during this challenging time. Your patients can join us to hear about staying healthy, managing stress, being active, and connecting with their community—all from the comfort of home!

      •Hosted by experts on preventive medicine, mental health, and other topics.
      •Participants can stay for all or part of these 30- to 45-minute events.
      •Participants can join by phone or online.

For more information or to join an event, visit our Staying in Touch Events page.

3/2020Managing Withdrawal From Alcohol Addiction During the COVID-19 Crisis

Read our provider notice on managing withdrawal from alcohol addiction during the COVID-19 crisis.

3/2020What You Need to Know About Coronavirus

As COVID-19 makes headlines, UPMC Health Plan wants to update you, our network provider, on decisions we have made that will affect you and our members, your patients. UPMC Health Plan is actively monitoring this evolving situation and timely, appropriate care for our members remains our top priority. We are working closely with county, state, and national health agencies and organizations to ensure that we are able to share critical, accurate information that allows both you and our Provider Services team to be prepared for new developments.

Read about billing updates.

Read about telehealth services.

Read our Community Care Behavioral Health Telehealth Services update.

3/2020Phenytoin Oral Suspension USP, 125 mg/5 mL

Taro Pharmaceuticals U.S.A. Inc. is recalling these two lot numbers of Phenytoin Oral Suspension USP,125 mg/5 mL, NDC# 51672-4069-1: #327874 and #327876 (expiration date December 2020). This recall is for safety reasons. Phenytoin Oral Suspension is used to treat seizures. Read the full text of the withdrawal.

3/2020Market Withdrawal: Belviq and Belviq XR (Lorcaserin)

The U.S. Food and Drug Administration (FDA) has asked Eisai Inc.—which manufactures the weight loss drugs Belviq and Belviq XR (lorcaserin)—to withdraw the drugs from the U.S. market because of a safety clinical trial that showed an increased occurrence of cancer. Read the full text of the withdrawal.

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