Important Notice Regarding Prior Authorizations for MP.PA.147
Jul. 2025Important Notices
UPMC Health Plan previously communicated that prior authorizations would be required under policy Diagnostic and Surveillance Colonoscopy, 18 Years Old and Older – MP.PA.147 effective June 1, 2025. However, the prior authorization requirement will be paused until Sept. 1, 2025.
Authorizations that have already been submitted will be entered without a review. Patient care should not be delayed or interrupted.
The provider is responsible for clinical decisions and billing. An authorization is not a guarantee of payment for services rendered.
Recent Announcements
Feedback sought on your experience with UPMC Health Plan
You may be invited to participate in a 2025 Press Ganey provider satisfaction survey, which will begin next month. This survey will be given to a random sampling of in-network primary care providers.Jul. 2025Important Notices
Feedback sought on your experience with UPMC Health Plan
You may be invited to participate in a 2025 Press Ganey provider satisfaction survey, which will begin next month. This survey will be given to a random sampling of in-network primary care providers.Jul. 2025Important Notices
Clinical documentation required for hip, knee, and shoulder prior authorizations
As you know, UPMC Health Plan requires certain clinical documentation/notes in support of a request for prior authorization for hip, knee, and shoulder procedures 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.Jul. 2025Important Notices