ACA Risk Adjustment Claims Submission Announcement
Feb. 2025Important Notices
Notice: Submit your claims for ACA members
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. The U.S. Department of Health & Human Services requires all issuers to submit their calendar year claims to the EDGE server by April 30 every year in order to provide more complete and an accurate picture of each patient’s health status. Any claims adjudicated after the deadline are not included for EDGE data submission.
You can submit claims through Provider OnLine at upmchealthplan.com/providers/medical. If you have any questions, please reach out to Provider Services or your physician account executive.
Recent Announcements
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