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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
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.

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Recent issues

September 2014

August 2014

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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...)