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PFFS Terms & Conditions

Explanation of Payment Forms Amended

Early this year, UPMC Health Plan installed a new computer software system that provides the company with many benefits through administrative efficiency and improved communications.

Network physicians, however, told us that one aspect of the new system ­ a combined explanation of payments for our Commercial, Medicare, and Medicaid product lines ­ was confusing to their staffs and made reporting difficult.

Because we want our new system to create efficiency for physicians as well as the Health Plan, we are changing how the software handles an explanation of payments (EOP) form.

To correct the problem, the Health Plan began mailing separate EOPs for each of our business lines on June 14, 2004. During a transition period, the Health Plan will also transmit separate reimbursement checks for each product line in an effort to make the EOP change as quickly as possible. However, because we know physicians do not require separate checks, we will eventually consolidate payments into a single check.

This change is the result of a positive dialogue with physicians related to our new software system. We appreciate all opinions and suggestions from our network providers, and we hope this recent change will ease any problems you have had with reporting and record keeping.