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
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 9:2Mar. 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