UPMC Health Plan

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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

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: Welcome and Key Contacts UPMC for Kids (CHIP) UPMC for Life (Medicare) Medical Management Member Administration Pharmacy Services UPMC Medicare Special Needs Plans
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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6/2012	New Online Continuing Medical Education (CME) Course — Earn 1.5 AMA PRA Category 1 Credits™ "Tackling Patient Adherence: Population-based Data and Patient-Centered Care in Chronic Disease Management" is a free online course that discusses patient barriers, clinical research, and ways to improve patient medication adherence. Click here to participate.
5/2012	Updated Medicare Non-Coverage (NOMNC) Form Per CMS Guidelines, UPMC HP has posted the most recent Notice of Medicare Non-Coverage (NOMNC) form on the UPMC Health Plan website. As a reminder SNFs, HHA and CORF providers are required to obtain a signed copy of the current CMS or MA Plan Specific NOMNC form from all members at least 2 days in advance of services ending. A non-current NOMNC form is considered void and invalid. Posted further down on this page are the UPMC for LIFE (PA), UPMC for LIFE SNP (PA), UPMC for LIFE (OH), and UPMC for LIFE (WV) current version of the CMS NOMNC. Please contact your network manager with any questions.
4/2012	Pharmacy Recall Notice Product Recall: Cyanocobalamin Injection (more...)
3/2012	Hospital Campus to Close UPMC Health Plan members will no longer be able to receive services at Altoona Regional Health System’s (ARHS) 7th Avenue Bon-Secours Campus (known as Mercy Hospital and Bon Secours-Holy Family Hospital), which closed on Wednesday, March 28, 2012. (more...)
3/2012	Pharmacy Recall Notice Product recall: Acetylcysteine solution (more...)
3/2012	Pharmacy Recall Notice Product recall: Oral contraceptives norgestimate and ethinyl estradiol tablets (more...)
1/2012	Walgreens/Take Care Clinics Update You probably already know that effective Jan. 1, 2012, Walgreens pharmacies were no longer participating providers in the UPMC Health Plan network. Regarding the Take Care Clinics located inside of Walgreen's, effective March 1, 2012, they also will no longer be participating providers in our network. Find another convenience care (retail) clinic.
11/2011	Provider Network Call Initiative The Department of Public Welfare (DPW) is continuing its Provider Network Call Initiative to ensure that consumers are receiving the highest quality of care and that the Managed Care Organizations (MCOs) are providing consumers with accurate information to allow them the ability to make the most informed decisions regarding their healthcare benefits. (more...)
10/2011	Pharmacy Recall Notice Product recall: Oral contraceptives (more...)
7/2011	Pharmacy Recall Notice Product recall: Butalbital, acetaminophen, and caffeine 50mg/325mg/40mg tablets and hydrocodone bitartrate and acetaminophen 7.5mg/500mg tablets (more...)
7/2011	Pharmacy Recall Notice Product recall: Endocet^® (oxycodone/acetaminophen) 10 mg/325 mg (more...)
7/2011	Pharmacy Recall Notice Product recall: RISPERDAL^® 3mg tablets and risperidone 2mg tablets (more...)
7/2011	Pharmacy Recall Notice Product recall: Concentrated sodium chloride injection 23.4%, 30 mL single dose vials (more...)
6/2011	Don't let language barriers get in the way of health care Members of UPMC for You have a right to receive information about health care in a way that they can understand it. ((more...)
5/2011	Pharmacy Recall Notice Product recall: Topamax 100mg tablets (more...)
4/2011	Pharmacy Recall Notice Product recall: Citalopram 10mg tablets and Finasteride 5mg tablets (more...)
4/2011	Pharmacy Recall Notice Product recall: Dexamethasone Sodium Phosphate Injection, USP, 4 mg/mL, 1 mL Single Dose Vials; 5 mL and 30 mL Multiple Dose Vials (more...)
4/2011	Medical Assistance Bulletin 2011 Recommended Childhood and Adolescent Immunization Schedules (more...)
3/2011	Free one-hour online CME program Improving Preventive Care in Medicare Patients: Focus on Key Measures Monitored by CMS in the Medicare Health Outcomes Survey (HOS) and the Consumer Assessment of Healthcare Providers and Systems (CAHPS) (more...)
3/2011	Pharmacy Recall Notice Product recall: Medications Manufactured by Upsher-Smith Laboratories (more...)
2/2011	Updated Medicare Non-Coverage (NOMNC) Form Per CMS Guidelines, UPMC HP has posted the most recent Notice of Medicare Non-Coverage (NOMNC) form on the UPMC Health Plan web site. As a reminder SNFs, HHA and CORF providers are required to obtain a signed copy of the current CMS or MA Plan Specific NOMNC form from all members at least 2 days in advance of services ending. A non-current NOMNC form is considered void and invalid. Posted further down on this page are the UPMC for LIFE (PA), UPMC for LIFE SNP (PA), UPMC for LIFE (OH), and UPMC for LIFE (WV) current version of the CMS NOMNC. Please contact your network manager if you have any questions.
2/2011	Pharmacy Recall Notice Product recall: Hydrocodone Bitartrate/Acetaminophen 10/500 mg and Phenobarbital 32.4 mg Tablets Manufactured by Qualitest Pharmaceuticals (more...)
2/2011	Pharmacy Recall Notice Product recall: Injectable Medication Kits Co-packaged with Triad Group Alcohol Prep Pads (more...)
1/2011	Pharmacy Recall Notice Product recall: Albuterol Sulfate Inhalation Solution manufactured by Ritedose Corporation (more...)
1/2011	Pharmacy Recall Notice Product recall: Metronidazole 250 mg tablets manufactured by Teva Pharmaceuticals (more...)
12/2010	Pharmacy Recall Notice Safety Announcement: FDA recommends against the continued use of propoxyphene (more...)
12/2010	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...)
12/2010	Medical Assistance Bulletin — Missed Appointments The purpose of this bulletin is to inform providers of the Medical Assistance (MA) policy regarding billing MA recipients for missed appointments (more...)
11/2010	Product Recall Fentanyl Transdermal System 25 mcg/hour manufactured by Actavis (more...)
10/2010	Product Recall Meridia (sibutramine) market withdrawal (more...)
10/2010	2010 Regional Meetings This 2010 Regional Meeting Series is a forum for health care professionals to explore and exchange ideas for enhancing patient care when utilizing the ever-expanding presence and applications of electronic communication. (more...)
10/2010	Product Recall EPOGEN^® and PROCRIT^® (Epoetin alfa) vials (more...)
1/2010	Product Recall Octagam [Immune Globulin Intravenous (Human)] 5% Liquid Preparation (more...)
8/2010	Product Recall Coumadin^® 1 mg blister packs (Bristol-Myers Squibb) (more...)
5/2010	*Referral of UPMC for Kids* (CHIP) Members to Medical Assistance All health plans that offer CHIP will identify current CHIP members with “serious health conditions” who may qualify for the Medical Assistance special health care needs program. (more...)**
4/2010	Improvements to Provider OnLine! A new Web-based application, online chat, and a new Security Officer position will improve security and efficiency. (more...)
3/2010	*UPMC for You* (Medical Assistance) Benefit Changes: Effective April 1, 2010 Details on the changes**
3/2010	Product Recall — OneTouch SureStep Test Strips (LifeScan) Attention: Diabetes health care professionals, consumers (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...)
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
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. (view DPW website...)

Recent issues

May 2013

April 2013

March 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.

Pennsylvania — UPMC for Life
Pennsylvania — UPMC for You Advantage
Pennsylvania — UPMC for Life Options
Pennsylvania — UPMC Community Care
West Virginia — UPMC for Life

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...)