• Right heart catheter CPT 93456 no longer requires an authorization.
• Left heart catheter CPT 93452 no longer requires an authorization.

• Provide medical professionals with information and data related to suicide
• Offer background on the National Suicide Prevention Lifeline, a national toll-free resource for anyone to call during a mental health crisis, including its new 988 phone number that gives Pennsylvanians access to 24/7 crisis support.
• Educate providers on the lifeline’s support, prevention, and crisis resources.
• Highlight the importance of educating patients, families and communities about the lifeline.

• Matthew B. Wintersteen, PhD, Associate Professor, Director of Research, Thomas Jefferson University/Jefferson Medical College, Department of Psychiatry & Human Behavior
• Alin Severance, MD, Medical Director, Behavioral Health Services, UPMC Health Plan; Associate Medical Director, Community Care Behavioral Health Organization

• An unvaccinated adult with poliovirus infection and acute flaccid paralysis.
• Wastewater detection in adjacent counties.

• People who are not vaccinated against polio.
• People who are under-vaccinated for polio and have traveled to areas with higher risk of polio or who have had contact with such persons.

• Understanding the difference between health equity and health equality.
• Recognizing key maternal and pediatric health disparity trends.
• Defining social determinants of health.
• Understanding the role providers, health plans, health systems, and communities have in recognizing health disparities and resources to improve those outcomes.

• Johanna Vidal-Phelan, MD, MBA, FAAP, Chief Medical Officer – Quality Department UPMC Insurance Services Division; Clinical Assistant Professor of Pediatrics University of Pittsburgh School of Medicine
• Katie Domalakes, MSW/LSW, Senior Director Clinical Affairs and Program Development, UPMC for You and UPMC for Kids, UPMC Health Plan
• Elana Glick, MPH, CPH, MCHES, NBC-HWC, Director, Clinical Programs Health Management, UPMC Health Plan
• Debra Zeh, RN, BSN, Senior Director of Quality Provider Performance, UPMC Health Plan

The FDA authorized bivalent formulations of the Moderna and Pfizer-BioNTech COVID-19 vaccines for use as a single booster dose at least two months after completing primary or booster vaccination. Anyone age 12 and older who has gotten the primary vaccination series with or without an additional booster is eligible.

• The Moderna COVID-19 Vaccine, Bivalent, is authorized for use as single booster dose in individuals 18 years old and older.
• The Pfizer-BioNTech COVID-19 Vaccine, Bivalent, is authorized for use as a single booster dose in individuals 12 years old and older.

• UPMC Health Plans provider FAQ
• Appendix A – COVID-19 Special Coverage and Payment Policy

• Retrospective Accuracy (RA) reviews. Cotiviti uses data from paid claims to conduct these reviews that help ensure appropriate coding. These reviews do not require additional documentation from the provider.
• Clinical Claim Validation (CCV) reviews. In these cases, Cotiviti reviews medical records to ensure appropriate billing. If a claim is identified for a CCV review, the provider will receive a letter that:
  • Identifies the selected the claim(s).
  • Requests detailed information on the selected the claim(s), including a required copy of the medical records, if UPMC Health Plan has not already received these medical records.
  Outlines the response guidelines and time frames.

• Pennsylvania enrollment site
• Toll-free number: 1-800-440-3989
  TTY: 1-800-618-4225
  Hours of operation: Monday – Friday, 8 a.m. – 6 p.m.

• Part 1: Screening and initial intervention
  Learn about the physiology, stigma, and effects of substance use disorder, among other topics related to screening and intervention.
• Part 2: Alcohol use disorder management
  Learn about medication management and non-medication interventions, among other aspects of alcohol use disorder.
• Part 3: Opioid use disorder management
  Learn about recommending medications for opioid use disorder (MOUD) and different MOUD options, among other aspects of opioid use disorder.
• Part 4: Overview of management and available resources
  Learn about continuum of care for a patient with a substance use disorder including available resources to assist non-addiction providers to meet the needs of these patients.

• How to define suicide screening and identify how often it should be used.
• Suicide assessment and when it should be done.
• How to gain greater familiarity with formulating a suicide risk assessment.
• Three suicide screening tools.
• How to locate resources to help develop a policy around suicide screening and assessment.

• Provides everyone with one simple pathway to reach out for help when thoughts of suicide or other increased mental health symptoms arise.
• Allows those with mental health crisis training and education and those knowledgeable about mental health resources within the caller’s community to respond appropriately.

1. The 988 number connects them to the National Suicide Prevention Lifeline, which answers calls via the new 988 number or through its existing 10-digit phone number, 1-800-273-8255.
   
   Note: Callers will also be given the option to reach the Veterans Crisis Line (Option 1) or a Spanish speaker (Option 2).
2. They are connected with a mental health crisis service provider in their area.
3. People can then receive telephonic crisis services or, when/where applicable, have mobile crisis services dispatched directly to them.

• If a child is an existing UPMC Childrens Community Pediatrics patient, they can schedule an appointment online or by calling your office.
• If a child is NOT an existing UPMC Childrens Community Pediatrics patient, patients can schedule by visiting Vaccine.UPMC.com or calling 1-844-UPMCVAC (1-844-876-2822) between 8 a.m. and 5 p.m., Monday through Friday.

• UPMC Health Plans provider FAQ
• Appendix A – COVID-19 Special Coverage and Payment Policy

• The use of as-needed courses of inhaled corticosteroids in the management of mild persistent asthma.
• The use of single-inhaler maintenance and reliever therapy (SMART) in moderate persistent asthma.
• Strategies and potential barriers to the implementation of new asthma management guidelines.
• Sharing UPMC Health Plan asthma resources.

• Erick Forno, MD, MPH, ATSF, Director, CHP Pediatric Asthma Center Division of Pediatric Pulmonary Medicine at UPMC Children’s Hospital of Pittsburgh/University of Pittsburgh School of Medicine
• Deborah Moss, MD, MPH, FAAP, Professor of Pediatrics, University of Pittsburgh Children’s Hospital of Pittsburgh of UPMC Division of General Academic Pediatrics; Pediatric Medical Director, UPMC for You; and Medical Director, UPMC for Kids
• Erin McConnell, PharmD, Program Manager, Pharmacy Quality, UPMC Health Plan

• A second booster dose of the Pfizer-BioNTech COVID-19 Vaccine or Moderna COVID-19 Vaccine may be administered to individuals 50 years of age and older at least four months after receipt of a first booster dose of any authorized or approved COVID-19 vaccine.
• A second booster dose of the Pfizer-BioNTech COVID-19 Vaccine or Moderna COVID-19 Vaccine may be administered to individuals who are moderately to severely immunocompromised at least four months after receipt of a first booster dose of any authorized or approved COVID-19 vaccine. The Pfizer-BioNTech COVID-19 Vaccine may be in administered to individuals 12 years of age and older and the Moderna COVID-19 Vaccine may be administered to individuals 18 years of age and older.
• A second booster dose of either the Pfizer-BioNTech or the Moderna COVID-19 vaccines may be administered at least four months after the first booster to individuals who have received one primary dose of the Johnson & Johnson/Janssen Vaccine with one subsequent booster of any COVID-19 vaccine.

• UPMC Health Plans provider FAQ
• Appendix A – COVID-19 Special Coverage and Payment Policy

• Of Payers
  • That payers verify and update the provider directory information not less frequently than once every 90 days.
  • That payers establish a process to remove providers from directories if the payer is unable to verify the providers’ information.
• Of Providers
  • Providers shall submit provider directory information to a plan or issuers, at a minimum:
    • When providers terminate a network agreement.
    • When there are material changes to the content of provider directory information.
    • At any other time (including upon the request of such issuer or plan).

1. Searching the online directory for your name at upmchealthplan.com/find. You can make updates to your information at upmchealthplan.com/providers/change.html.
2. Searching Provider OnLine under ""Reports,"" ""Office Information Sheet."" Changes can be noted on the sheet and returned to the email address below. (If this section is not available to you, you can request access via your online administrator.)

• UPMC Health Plans provider FAQ
• Appendix A – COVID-19 Special Coverage and Payment Policy

• Present data regarding the prevalence and impact of SUDs on society and health care.
• Provide an overview of feasible screening, brief intervention, and referral to treatment processes, including reimbursement opportunities.
• Review basic medical management principles for patients with SUDs.
• Describe existing support and referral resources available to Pennsylvania providers to connect patients to ongoing care.

• The concepts of quality and value and how they apply to health care.
• The components of a quality measure.
• HEDIS, CAHPS, and NCQA roles in quality measures.
• Best practices for select pediatric, behavioral, and adult measures.

• Background, prevalence, and best practices
• Available supports and services at UPMC Health Plan such as the RxWell app, behavioral health condition management, and case management
• How to prescribe these and other UPMC Health Plan supports and services with UPMC Prescription for Wellness
• Reimbursement and potential incentives for depression screening

• Alin Severance, MD, Medical Director, Behavioral Health Services at UPMC Health Plan; Associate Medical Director, Community Care Behavioral Health Organization
• Jamie Delu, RRT, Director, Prescription for Wellness at UPMC Health Plan
• Laura Francis, MSW, LSW, Program Director, Behavioral Integration at UPMC Health Plan
• Rebecca Knoll, MPH, Director, Quality Provider Performance at UPMC Health Plan
• Tanuja Tripurana, BTech in Mechanical Engineering, Senior Manager, RxWell at UPMC Health Plan