Medical Management Resources

This section houses the UPMC Health Plan Quick Reference Guides (QRG) — one guide for each product line. The Quick Reference Guides provide a snapshot of prior authorization and referral requirements.
	Commercial QRG UPMC for Life QRG UPMC for You QRG UPMC for Kids QRG UPMC for Life Specialty Plan QRG PFFS QRG

Patient Health Guidelines

• Utilization Management Criteria
• Clinical Guidelines
• Preventive and Immunization Guidelines
• Medical Necessity Statement Describing How Health Plan Decisions Are Made
• Medical Record Documentation Guidelines

Physician Forms

• Diabetic Eye Examination Scanning Form
• Obstetrical Needs Assessment Form