PROVIDERS
The Region's Only Provider-Led Plan
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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
| 3/2010 | Product Recall — OneTouch SureStep Test Strips (LifeScan) Attention: Diabetes health care professionals, consumers more ... |
| 12/2009 | Department of Health to Offer H1N1 Vaccine Clinics for All Pennsylvanians Appointments may be made at H1N1inPA.com or by phone. more ... |
| 12/2009 | Braddock Hospital Closure As you are probably aware, UPMC has announced plans to close UPMC Braddock on January 31, 2010, terminating the hospital’s current contract with UPMC Health Plan. more ... |
| 12/2009 | 2010 CPT Code Changes Beginning January 1, 2010, the Centers for Medicare & Medicaid Services (CMS) will be eliminating the use of Evaluation and Management (E&M) Consultation CPT Codes (99241-99255) for its Medicare providers and requiring them to bill the most appropriate office visit or hospital inpatient CPT Codes (99201-99215, 99221-99239). more ... |
| 11/2009 | Regional Meeting Were you unable to make it to the 2009 Regional Meetings? Don't worry, all the information you need is attached here! This year we covered Care Coordination, Diagnosis Coding, Secondary Diagnosis and much more. Partners Care Coordination Presentation |
| 10/2009 | PA Regional Extension Center/QIP Collaborative to Assist Physicians |
| 10/2009 | Formulary Updates UPMC Health Plan regularly updates it formulary, which may include adding new therapies as approved by the U.S. Food and Drug Administration and, occasionally, removing medications from the list. View a PDF of the formulary updates... |
| 10/2009 | UPMC for You initiative reminder |
| 10/2009 | UPMC for Life & UPMC for Life Specialty Plan initiative reminder |
| 9/2009 | Provider OnLine Reactivation Request If you have not accessed your Provider OnLine account in the past six months your account may be disabled. Request that your account be reactivated |
| 9/2009 | H1N1 (Swine) Flu Information The Pennsylvania Department of Health (DOH) is extending the opportunity for health care providers to administer the H1N1 influenza vaccine ... more |
| 4/2009 | Guide to New Member ID Cards UPMC Health Plan recently distributed 500,000 magnetic-stripe ID cards to current members. These new ID cards will provide added convenience to providers by saving time and reducing errors. When swiped through the appropriate card reader system in a provider's office, these ID cards will instantly check a member's eligibility and benefits and enable providers to automatically populate the information on UPMC Health Plan Provider OnLine portal pages. Learn more about the new member ID cards |
| 3/2009 | Medical Assistance Provider Self-Audit Tool The Department of Public Welfare (DPW) has recently developed a formal protocol for disclosing overpayments or improper payments of Medical Assistance (MA) funds. More on DPW website... |
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Recent issues |
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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...