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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
For Dental Providers
For Vision Care Providers
4/2013 Pharmacy Recall Notice
Product recall: Sodium Chloride 0.9% Injection Containers (more...)
4/2013 Free Classes Available to Providers and Staff
UPMC Health Plan offers a variety of classes. Classes cover coding and documentation, risk adjustment, electronic records, and medical records requirements. View the complete listing for this quarter here. To register for a class, send an email to riskadjustment@upmc.edu. You can also call 412-454-7266 or 412-454-5904.

4/2013 Good News
The numbers don’t lie! And we like what they say. View some important statistics that make us proud.
2/2013 Pharmacy Recall Notice
Product recall: Vistide (cidofovir) injectable vials (more...)
2/2013 Fraud and Abuse Training
For health care providers and staff involved with the Medicare program, CMS requires — and UPMC Health Plan provides — compliance and fraud, waste, and abuse training. Within the first 90 days of new hire or contract start date, providers and staff need to complete the training. Thereafter they should complete the training annually. Get started on your training today by reviewing this presentation.

1/2013 Medical Assistance Increases Primary Care Services Rate
For 2013 and 2014, the Department of Public Welfare is increasing fees for Medical Assistance (MA) primary care services. Section 1202 of the Patient Protection and Affordable Care Act (ACA) requires the increase to be no less than the Medicare Physician Fee Schedule rate for the two calendar years.

MA-enrolled physicians can qualify for the increased primary care services rate if they specialize in family, internal, or pediatric medicine. Providers can find additional information on who is eligible and how to qualify at http://services.dpw.state.pa.us/olddpw/bulletinsearch.aspx?BulletinDetailId=4893.

Providers can find the most current information on Section 1202 at www.dpw.state.pa.us/provider/acaphysicianfeeincreasesforpcs/index.htm.

12/2012 Pharmacy Recall Notice
Product recall: Carboplatin injectable vials (more...)
11/2012 Pharmacy Recall Notice
Product recall: Ranbaxy’s Atorvastatin 10mg, 20mg, and 40mg tablets (more...)
11/2012 RadPort Update
Changes are coming to RadPort. Log in to Provider OnLine for details.
9/2012 Pharmacy Recall Notice
Product recall: Nimodipine capsules (more...)
9/2012 Provider Manual Updates
The following sections of the UPMC Health Plan provider manual were recently updated:
9/2012 Pharmacy Recall Notice
Product recall: Qualitest's hydrocodone-acetaminophen 10 mg/500 mg tablets (more...)
8/2012 Provider Quick Tips from DPW
Medical Assistance (MA) Providers and Managed Care Organizations (MCOs) Must Ensure Continuity of Care During HealthChoices (HC) Expansion (more...)
8/2012 Pharmacy Recall Notice
Product recall: Hospira injectable drugs (more...)
7/2012 Pharmacy Recall Notice
Product recall: Introvale contraceptive tablets (more...)
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May 2013

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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...)