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providers The Region's Only Provider-Led Plan

As the only provider-led health insurer in Western Pennsylvania, we recognize the importance of partnership with network physicians and sensitivity to doctor-patient relationships.

Announcements
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7/2014 Not all preventive screenings are EHBs
Under the Affordable Care Act, certain preventive services, known as Essential Health Benefits (EHB), are covered at 100 percent. However, not all preventive screenings are EHBs. A screening may be preventive and medically necessary, but if it is not on the list of EHBs, your patient may have a cost share. For a complete list of all preventive services covered at 100 percent, visit
www.healthcare.gov/what-are-my-preventive-care-benefits/#part=1. If there are any questions, you can call Provider Services at 1-866-918-1595 for clarification. Or members can call a Health Care Concierge at the number listed on the back of their card.

4/2014 Medicaid revalidation of enrollment
The Department of Public Welfare (DPW) must revalidate the enrollment of all providers at least every five years. In order to do this, DPW requires that all providers re-enroll at least every five years by submitting a fully completed Pennsylvania PROMISe™ Provider Enrollment Application for every active and current service location. The Department is requiring all currently enrolled providers to complete the re-enrollment process by March 24, 2016. Please allow adequate time for application processing and screening (at least 60 to 90 days) in meeting the March 24, 2016 and subsequent revalidation enrollment deadlines. For more information, see Medical Assistance Bulletin 99-14-06. You can determine your next re-enrollment deadline by logging into the provider portal for each service location. Access the enrollment requirements and application.

4/2014 Available soon: A new version of Beating the Blues US™!
We hope you will recommend this online program to patients who might benefit, whether they’re coping with day-to-day stress, anxiety, or mild-to-moderate depression. It’s easy-to-use, convenient, and free for members of UPMC Health Plan. Call 1-855-772-8762 or email healthplansparef@upmc.edu to contact your health management outreach liaison for more information.

4/2014 Pharmacy Recall Notice
Product recall: Effexor XR or generic venlafaxine ER capsules (more...)
3/2014 Capture the details.
When it comes to managing your patients’ health, there’s no such thing as too much information.


It’s important to paint a detailed picture of each patient after every encounter. Be sure to include any chronic conditions. Complete, accurate coding improves the quality and coordination of your patients’ care.

Need to boost your coding expertise? We offer resources to help you and your staff prepare for ICD-10. View a schedule of free classes.

To register, email riskadjustment@upmc.edu. You can also call 412-454-7266 or 412-454-5904.

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Medical Assessment Form PA 635

DPW is working with the Managed Care and Behavioral Health Managed Care Organizations to let you know that a revised Medical Assessment Form PA 635 will soon be in use.  DPW is planning to implement a Work Ready Screening Tool and Medical Assessment and Treatment Plan pilot in Allegheny County. (more...)


Medicare Non-Coverage Appeal Rights

These forms are for Skilled Nursing Facilities, Comprehensive Outpatient Rehabilitation Facilities, and Home Health Providers. UPMC for Life participating providers may now use the UPMC Health Plan-specific Notice of Medicare Non-Coverage (NOMNC) forms required by CMS.


Important Message from Medicare

On November 27, 2006, the Centers for Medicare & Medicaid Services (CMS) published a final rule, CMS-4105-F: Notification of Hospital Discharge Appeal Rights. Beginning July 2, 2007, hospitals must deliver a revised version of the Important Message from Medicare to inform Medicare beneficiaries who are hospital inpatients about their hospital discharge appeal rights. This notice is required for every Medicare beneficiary. Beneficiaries who choose to appeal a discharge decision will receive a more detailed notice. The most current versions of these forms are available on the CMS website.

Please continue to visit the CMS website for more information on the above forms, and to print the most current versions of these forms, at http://www.cms.hhs.gov/BNI/12_HospitalDischargeAppealNotices.asp.


Managed Care Organizations' Providers are Required to Register their NPI Numbers with DPW

Managed Care Organizations’ providers are required to register their National Provider Identifier (NPI) numbers with the Department of Public Welfare (DPW). The link below provides instructions for registering NPI numbers with DPW. (more...)