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

Special notice: Important policy changes

Effective June 1, 2025, UPMC Health Plan will be implementing policy changes that will require providers to obtain prior authorizations for services listed in the following policies. For more information, please visit upmchp.us/policiesandprocedures.
May 2025Important Notices

Provider OnLine Enhancements

Provider OnLine will be launching enhancements to the authorization process on April 18, 2025. The enhancement will include the following updates:
Apr. 2025Important Notices

Fostering Trust in Vaccinations Through Shared Decision Making

Please join us for a live, CME-accredited webinar on Wednesday, June 4, from noon to 1 p.m. that will provide an overview of fostering trust in vaccinations through shared decision making.
Apr. 2025Education/Webinars