UPMC for You is expanding across Pennsylvania in September!

Jun. 2022Important Notices
"We are excited to announce that the Pennsylvania Department of Human Services (PA-DHS) has awarded UPMC for You a Medicaid Managed Care Contract for all five Physical HealthChoices zones across the Commonwealth of Pennsylvania. UPMC for You currently serves the Northwest, Southwest, and Lehigh/Capital HealthChoices zones and will expand into the Northeast and Southeast zones, effective Sept. 1, 2022.*

After June 22, 2022*, your Medicaid patients will receive a letter from PA-DHS to let them know about the Medicaid Managed Care Organizations (MCOs) selected to service their HealthChoices zones. Please look for a provider toolkit arriving in the mail in the coming weeks, explaining various value-added benefits for your patients and a variety of materials to display in your office. You can also review a list of frequently asked questions at upmchp.us/ProviderFAQ.

*Go-live implementation dates and communication timelines are subject to change at discretion of the Pennsylvania Department of Human Services."

Recent Announcements

PA DOH Antibiotic Stewardship Resources

Order antibiotic stewardship resources at no cost
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Medical device correction: Omnipod (Insulet – May 2026)

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Clinical documentation required for medical policy prior authorizations

As you know, UPMC Health Plan requires certain clinical documentation/notes in support of a request for prior authorization for the listed procedures below in accordance with its established policies and procedures, in addition to CMS requirements that medical record documentation must support the medical necessity of the services requested.
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