Featured Announcements

Important updates on influenza prevention and treatment

As we continue to navigate flu season, we want to emphasize three critical areas to ensure the health and safety of your patients who are UPMC Health Plan members: Consider antiviral therapy when appropriate, encourage masking to prevent the spread of respiratory viruses, and continue to recommend the flu vaccine.
Feb. 2025Important Notices

Recent Announcements

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

Please join us for a live, CME-accredited webinar on Wednesday, Sept. 10 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.
Jun. 2025Education/Webinars

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

Please join us for a live, CME-accredited webinar on Wednesday, Sept. 10 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.
Jun. 2025Education/Webinars

CME webinar series: Empowering Providers on Substance Use Disorders

Register for our new CME webinar series: Empowering Providers on Substance Use Disorders
Jun. 2025Education/Webinars

CME webinar series: Empowering Providers on Substance Use Disorders

Register for our new CME webinar series: Empowering Providers on Substance Use Disorders
Jun. 2025Education/Webinars

Voluntary nationwide recall: Sulfamethoxazole/Trimethoprim (Amneal – June)

Amneal Pharmaceutical LLC is recalling certain lots of Sulfamethoxazole/Trimethoprim Tablets, USP, 400 mg/80 mg. Sulfamethoxazole/Trimethoprim is used for the treatment of certain bacterial infections.
Jun. 2025Pharmacy Updates

Voluntary nationwide recall: Sulfamethoxazole/Trimethoprim (Amneal – June)

Amneal Pharmaceutical LLC is recalling certain lots of Sulfamethoxazole/Trimethoprim Tablets, USP, 400 mg/80 mg. Sulfamethoxazole/Trimethoprim is used for the treatment of certain bacterial infections.
Jun. 2025Pharmacy Updates

Important update: Rite Aid pharmacy closures and patient transition support

The closure of Rite Aid pharmacy locations may significantly impact UPMC Health Plan members’ ability to access their medications in a timely manner.
Jun. 2025Important Notices

Important update: Rite Aid pharmacy closures and patient transition support

The closure of Rite Aid pharmacy locations may significantly impact UPMC Health Plan members’ ability to access their medications in a timely manner.
Jun. 2025Important Notices

UPMC for Kids now provides statewide CHIP coverage

Effective July 1, 2025, comprehensive high-quality health insurance coverage is available to even more children and teens throughout the state. UPMC for Kids, UPMC Health Plan’s Children’s Health Insurance Program (CHIP) plan, has expanded into three additional counties across Pennsylvania to include Montour, Northumberland, and Pike.
Jun. 2025Education/Webinars

UPMC for Kids now provides statewide CHIP coverage

Effective July 1, 2025, comprehensive high-quality health insurance coverage is available to even more children and teens throughout the state. UPMC for Kids, UPMC Health Plan’s Children’s Health Insurance Program (CHIP) plan, has expanded into three additional counties across Pennsylvania to include Montour, Northumberland, and Pike.
Jun. 2025Education/Webinars

UPMC-GoHealth Urgent Care centers opening

UPMC has formed a joint venture with GoHealth Urgent Care. MedExpress locations in PA and WV and UPMC Urgent Care and Express Care centers are transitioning to UPMC-GoHealth Urgent Care centers.
Jun. 2025Important Notices

UPMC-GoHealth Urgent Care centers opening

UPMC has formed a joint venture with GoHealth Urgent Care. MedExpress locations in PA and WV and UPMC Urgent Care and Express Care centers are transitioning to UPMC-GoHealth Urgent Care centers.
Jun. 2025Important Notices

Fostering Trust in Vaccinations Through Shared Decision Making

Please join us for a live, CME-accredited webinar on Thursday, September 11, from noon to 1 p.m. that will provide an overview of fostering trust in vaccinations through shared decision making.
May 2025Education/Webinars

Fostering Trust in Vaccinations Through Shared Decision Making

Please join us for a live, CME-accredited webinar on Thursday, September 11, from noon to 1 p.m. that will provide an overview of fostering trust in vaccinations through shared decision making.
May 2025Education/Webinars

Pause in Prior Authorization Policies

On April 1, 2025, we announced that UPMC Health Plan would start requiring prior authorization for certain services. Please note that we are delaying or changing the implementation of prior authorization for some of these services, as described below.
May 2025Important Notices

Pause in Prior Authorization Policies

On April 1, 2025, we announced that UPMC Health Plan would start requiring prior authorization for certain services. Please note that we are delaying or changing the implementation of prior authorization for some of these services, as described below.
May 2025Important Notices

May is Mental Health Awareness Month

“Turn Awareness into Action”Mental Health America founded Mental Health Month in 1949, and since that time, every May has been a time to unite millions of people to promote awareness, provide vital resources, and advocate for everyones mental well-being. 1 in 5 people will experience a mental health condition in any given year¹. Mental health affects us all, and its critical that we move beyond awareness to take meaningful steps for our well-being and that of our community.
May 2025Important Notices

May is Mental Health Awareness Month

“Turn Awareness into Action”Mental Health America founded Mental Health Month in 1949, and since that time, every May has been a time to unite millions of people to promote awareness, provide vital resources, and advocate for everyones mental well-being. 1 in 5 people will experience a mental health condition in any given year¹. Mental health affects us all, and its critical that we move beyond awareness to take meaningful steps for our well-being and that of our community.
May 2025Important Notices

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

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

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

HPV Vaccination Resources

To help protect against cancers later in life, it is important to increase HPV vaccination rates in adolescents starting at age 9. According to the Centers for Disease Control and Prevention, HPV vaccination is routinely recommended at age 11 or 12, but the vaccine can be given starting at age 9.1 The Pennsylvania Cancer Coalition cites the following potential benefits of initiating the HPV vaccine series at age 9:2
Mar. 2025Important Notices

HPV Vaccination Resources

To help protect against cancers later in life, it is important to increase HPV vaccination rates in adolescents starting at age 9. According to the Centers for Disease Control and Prevention, HPV vaccination is routinely recommended at age 11 or 12, but the vaccine can be given starting at age 9.1 The Pennsylvania Cancer Coalition cites the following potential benefits of initiating the HPV vaccine series at age 9:2
Mar. 2025Important Notices

Special notice: Important policy changes

Effective May 1, 2025, the following policies will be retired and replaced with prior authorization policies. For more information, please visit upmchp.us/policiesandprocedures.
Mar. 2025Important Notices

Special notice: Important policy changes

Effective May 1, 2025, the following policies will be retired and replaced with prior authorization policies. For more information, please visit upmchp.us/policiesandprocedures.
Mar. 2025Important Notices

CME Webinar: Essential Best Practices for Newborn Care: Ensuring Healthy Beginnings Through Comprehensive Care

Please join us for a live, CME-accredited webinar on Wednesday, May 7, from noon to 1 p.m. that will provide an overview of newborn care.
Feb. 2025Education/Webinars

CME Webinar: Essential Best Practices for Newborn Care: Ensuring Healthy Beginnings Through Comprehensive Care

Please join us for a live, CME-accredited webinar on Wednesday, May 7, from noon to 1 p.m. that will provide an overview of newborn care.
Feb. 2025Education/Webinars

2025 Preventative Care Rewards Program

We’re excited to continue our preventive care rewards program in 2025. This program allows eligible UPMC for Life patients to earn rewards when they complete certain preventive services, such as an annual wellness visit, a breast cancer screening, a colorectal cancer screening, or a diabetic retinal eye exam (for members with diabetes only).
Feb. 2025What's New

2025 Preventative Care Rewards Program

We’re excited to continue our preventive care rewards program in 2025. This program allows eligible UPMC for Life patients to earn rewards when they complete certain preventive services, such as an annual wellness visit, a breast cancer screening, a colorectal cancer screening, or a diabetic retinal eye exam (for members with diabetes only).
Feb. 2025What's New

CME Webinar: Asthma Clinical Guideline Updates

Please join us for a live, CME-accredited webinar on Wednesday, April 30, that will provide an overview of asthma clinical guideline updates.
Feb. 2025Education/Webinars

CME Webinar: Asthma Clinical Guideline Updates

Please join us for a live, CME-accredited webinar on Wednesday, April 30, that will provide an overview of asthma clinical guideline updates.
Feb. 2025Education/Webinars

HIPAA Fax Line Permanently Closed as of 2/1/2025

The UPMC Health Plan HIPAA Fax Line 412-454-7829 has been permanently closed and is no longer receiving faxes. The most efficient way to submit a PRD (Personal Representative Designation) form is for the member to do so via the Member Site (Digital Account).
Feb. 2025Important Notices

HIPAA Fax Line Permanently Closed as of 2/1/2025

The UPMC Health Plan HIPAA Fax Line 412-454-7829 has been permanently closed and is no longer receiving faxes. The most efficient way to submit a PRD (Personal Representative Designation) form is for the member to do so via the Member Site (Digital Account).
Feb. 2025Important Notices

ACA Risk Adjustment Claims Submission Announcement

UPMC Health Plan would like to remind all network providers to submit all outstanding CY 2024 claims for ACA members (Platinum, Gold, Silver, and Bronze plans), no later than April 1, 2025.
Feb. 2025Important Notices

ACA Risk Adjustment Claims Submission Announcement

UPMC Health Plan would like to remind all network providers to submit all outstanding CY 2024 claims for ACA members (Platinum, Gold, Silver, and Bronze plans), no later than April 1, 2025.
Feb. 2025Important Notices

Artificial Intelligence for Medical Professionals – What You Need to Know

Please join us for a live, CME-accredited webinar on Wednesday, March 26, from noon to 1 p.m. that will provide an overview of artificial intelligence for medical professionals.

Jan. 2025Important Notices

Artificial Intelligence for Medical Professionals – What You Need to Know

Please join us for a live, CME-accredited webinar on Wednesday, March 26, from noon to 1 p.m. that will provide an overview of artificial intelligence for medical professionals.

Jan. 2025Important Notices

Building Trust: Person-Centered Strategies for Effective Decision Making and Preventive Care

Please join us for a live, CME-accredited webinar on Tuesday, Feb. 18, from noon to 1 p.m. that will review person-centered strategies for effective decision making and preventive care.

Jan. 2025Important Notices

Building Trust: Person-Centered Strategies for Effective Decision Making and Preventive Care

Please join us for a live, CME-accredited webinar on Tuesday, Feb. 18, from noon to 1 p.m. that will review person-centered strategies for effective decision making and preventive care.

Jan. 2025Important Notices

Xylazine-Associated Wounds: Considerations for Antimicrobial Stewardship and Wound Care

Please join us for a live, CME-accredited webinar on Tuesday, Feb. 25, from noon to 1 p.m. that will educate providers on the important topic of xylazine associated wounds.

Jan. 2025Important Notices

Xylazine-Associated Wounds: Considerations for Antimicrobial Stewardship and Wound Care

Please join us for a live, CME-accredited webinar on Tuesday, Feb. 25, from noon to 1 p.m. that will educate providers on the important topic of xylazine associated wounds.

Jan. 2025Important Notices

An updated version of the Notice of Medicare Non-Coverage (NOMNC) is available as of Jan. 9, 2025

If you have printed copies of the NOMNC form, please discontinue using them after Jan. 9, and replace them with the most current version. An updated form is now available on our website at the link below.
Jan. 2025Important Notices

An updated version of the Notice of Medicare Non-Coverage (NOMNC) is available as of Jan. 9, 2025

If you have printed copies of the NOMNC form, please discontinue using them after Jan. 9, and replace them with the most current version. An updated form is now available on our website at the link below.
Jan. 2025Important Notices

Voluntary nationwide recall: Systane (Alcon – December)

Alcon Laboratories is recalling one lot, lot 10101, of Systane Lubricant Eye Drops Ultra PF, Single Vials On-the-Go. Systane Lubricant Eye Drops. Ultra PF is used for the temporary relief of burning and irritation in persons with dry eye symptoms.
Jan. 2025Pharmacy Updates

Voluntary nationwide recall: Systane (Alcon – December)

Alcon Laboratories is recalling one lot, lot 10101, of Systane Lubricant Eye Drops Ultra PF, Single Vials On-the-Go. Systane Lubricant Eye Drops. Ultra PF is used for the temporary relief of burning and irritation in persons with dry eye symptoms.
Jan. 2025Pharmacy Updates

Voluntary nationwide recall: Prograf and Astagraf (Astellas – December)

Astellas Pharma US, Inc. is recalling one lot of Prograf, lot 0E3353D, and one lot of Astagraf XL, lot 0R3092A. Prograf and Astagraf XL are used in conjunction with other medicines to help prevent organ transplant rejection.
Jan. 2025Pharmacy Updates

Voluntary nationwide recall: Prograf and Astagraf (Astellas – December)

Astellas Pharma US, Inc. is recalling one lot of Prograf, lot 0E3353D, and one lot of Astagraf XL, lot 0R3092A. Prograf and Astagraf XL are used in conjunction with other medicines to help prevent organ transplant rejection.
Jan. 2025Pharmacy Updates

Coming soon: Formulary updates effective Jan. 1, 2025

Please review updated information for the prescription drugs covered under each plan.

UPMC Health Plan Commercial plans

Jan. 2025Important Notices

Coming soon: Formulary updates effective Jan. 1, 2025

Please review updated information for the prescription drugs covered under each plan.

UPMC Health Plan Commercial plans

Jan. 2025Important Notices

UPMC Health Plan medical drug coverage updates

UPMC Health Plan initiated changes to certain medical drug coverage policies for all lines of business on Jan. 1, 2025. Please visit upmchp.us/pharm-services-medical for more information. If you have questions about the changes, call Provider Services at 1-866-918-1595. Thank you for your continued support and for the great care you provide our members.

Jan. 2025Important Notices

UPMC Health Plan medical drug coverage updates

UPMC Health Plan initiated changes to certain medical drug coverage policies for all lines of business on Jan. 1, 2025. Please visit upmchp.us/pharm-services-medical for more information. If you have questions about the changes, call Provider Services at 1-866-918-1595. Thank you for your continued support and for the great care you provide our members.

Jan. 2025Important Notices