Skip to main content
Providers

Announcements

03/2024Change Healthcare incident update
UPMC Health Plan is aware that operations at many of our valued provider partners have been impacted by an incident at Change Healthcare. We are committed to working collaboratively with providers to ensure continuity of business operations.

Please note that UPMC Health Plan is not experiencing any direct outages to core systems or functions at this time. Our prior authorization, eligibility status, claims processing, and claims payment processes are fully operational, and UPMC Health Plan’s provider portal, Provider OnLine, is fully functional and available. Providers can continue to submit claims, check eligibility and benefits, and request prior authorization through Provider OnLine without any disruptions. Additional information is available for reference.
04/2024Voluntary nationwide recall: Methocarbamol (Eugia – March)
Eugia US LLC is recalling one lot of Methocarbamol Injection, USP 1000 mg/10 mL (100 mg/mL). Methocarbamol is used for the relief of discomfort from acute, painful musculoskeletal conditions.

This drug is being recalled because white particles were found in one vial during a customer’s inspection. Using an injectable product that contains particulate matter may cause local irritation or swelling. It may also block blood vessels, leading to life-threatening blood clot events.

As of the date of Eugia’s recall announcement, March 28, 2024, there have been no reports of adverse events related to this recall. To see if your medication was recalled, contact your doctor or pharmacy where you received the medication or visit the FDA website below.

If you have an affected lot of Methocarbamol, you should stop using the item and return it to the place of purchase.

To learn more about this recall, you can take one or more of the steps below.
  • Talk to your doctor or pharmacist.
  • Call Eugia US LLC at 866-850-2876, option 2. TTY users should call 711. Help is available Monday through Friday from 8 a.m. to 5 p.m. EST.
  • Visit the FDA website.
04/2024Voluntary nationwide recall: Vancomycin (Amneal – March)
Amneal Pharmaceuticals, LLC is recalling four lots of Vancomycin Hydrochloride for Oral Solution, USP, 250 mg/5 mL. Vancomycin is used for treatment of certain bacterial infections.

This drug is being recalled because some bottles may have been overfilled. This may cause a higher dose to be received and may increase adverse effects, such as kidney damage.

As of the date of Amneal’s recall announcement, March 27, 2024, there have been no reports of adverse events related to this recall. To see if your medication was recalled, contact your doctor or pharmacy where you received the medication or visit the FDA website below.

If you have an affected lot of Vancomycin, you should stop using the item and return it to the place of purchase.

To learn more about this recall, you can take one or more of the steps below.
  • Talk to your doctor or pharmacist.
  • Call Amneal at 1-833-582-0812. TTY users should call 711. Help is available Monday through Friday from 8 a.m. to 5 p.m. EST.
  • Visit the FDA website.
04/2024Options to check member eligibility
If you are unsure about a member's insurance coverage, please use their PROMISe™ ID or Provider OnLine to confirm their eligibility. There are no eligibility dates on member ID cards. The date printed ona member ID card is not the member's date of eligibility; it is the card’s print date.
04/2024Notice: Submit your claims for ACA members
UPMC Health Plan would like to remind all network providers to submit all outstanding calendar year 2023 claims for ACA members no later than April 15, 2024. HHS requires all issuers to submit their calendar year claims to the EDGE server by April 30 every year in order to provide a more complete and accurate picture of each patient’s health status. Any claims adjudicated after the deadline are not included for EDGE data submission.

Claims can be submitted via the secure portal.

If you have any questions, please contact Provider Services or your physician account executive.
04/2024Self-servicing update
Beginning Monday, April 15, 2024, UPMC Health Plan participating providers who need a general claim status, member eligibility or benefit information, help creating or verifying on an authorization, assistance accessing an EOP, or to check information will be required to use our self-servicing options on our online portal at upmchealthplan.com/providers or our Interactive Voice Response system (IVR). If you have any questions, please contact the Provider Services Web Support Team at 1-800-937-0438.
03/2024CME webinar: Hepatitis C, B, and HIV: Screening and Management
Please join us for a live, continuing medical education (CME)-accredited webinar on Wednesday, May 1, from noon to 1 p.m. The webinar will provide an overview of hepatitis C, B, and HIV screening and management. During this presentation, our expert will:
  • Review the prevalence, trends, and screening recommendations for hepatitis B, C, and HIV.
  • Discuss recommended screening tests and the interpretation of the results.
  • Review the management of hepatitis C and the role of primary care in its treatment.
  • Discuss considerations with hepatitis C, B, and HIV coinfections.

Presenter:
Nicholas DeGregorio, MD, MMM, FACP​,
Associate Vice President, Medicaid Medical Services,​ UPMC Health Plan

Register now.

This webinar will be recorded.

This activity is approved for AMA PRA Category 1 Credit™ and ANCC. Other health care professionals will receive a certificate of attendance confirming the number of contact hours commensurate with the extent of participation in this activity.

This activity has been designated as and meets the Pennsylvania licensure requirement for Patient Safety-Risk Management Credit. It is the responsibility of the learner to maintain the educational presentation or conference agenda as evidence, if needed for audit purposes.

Provider is responsible for verifying CME eligibility.
03/2024CME webinar: UPMC Health Plan Quality of Care Process (recorded)
Please make time to listen to this on-demand, continuing medical education (CME)-accredited webinar on UPMC Health Plan’s Quality of Care Process. Michael Lynch, MD, FACMT, discusses a range of learning objectives to educate viewers around this topic during the webinar.

This webinar will cover:
  • Evidence related to patient safety events.
  • Regulatory requirements guiding UPMC Health Plan Quality of Care (QOC) processes.
  • QOC case referral and review procedures.
  • Case examples.

Presenter:
Michael Lynch, MD, FACMT
Senior Medical Director, UPMC Health Plan Quality and Substance Use Disorder Services;
Associate Professor of Emergency Medicine and Medical Toxicology, University of Pittsburgh School of Medicine

Watch now

You may earn continuing medical education (CME) credits for attending this webinar. This activity is approved for AMA PRA Category 1 Credit™ and ANCC. Other health care professionals will receive a certificate of attendance confirming the number of contact hours commensurate with the extent of participation in this activity.

This activity has been designated as and meets the Pennsylvania licensure requirement for Patient Safety-Risk Management Credit. It is the responsibility of the learner to maintain the educational presentation or conference agenda as evidence, if needed for audit purposes.

Provider is responsible for verifying CME eligibility.
03/2024What providers need to know about charging UPMC for Life Complete Care members cost sharing
The new year has brought important changes to UPMC for Life Complete Care (HMO D-SNP) grace periods. For providers, this affects their ability to charge some UPMC for Life Complete Care members cost sharing. Read this article in Provider Partner Update to learn about who providers can charge cost sharing, exceptions to the rule, and more.
03/2024Provider Documentation and Coding Educational CME webinar: Cancer Documentation and ICD-10-CM Coding
Please join UPMC Health Plan’s Risk Adjustment/HCC Coding Education Program Director Marlana Tice for a live, continuing medical education (CME)-accredited webinar on Thursday, May 16, from noon to 1 p.m., that will provide an overview on cancer documentation and ICD-10-CM Coding.

During this presentation, viewers will gain a comprehensive understanding of official documentation and coding guidelines needed for proper cancer reporting, focusing on:
  • “History of” documentation.
  • Definitions of active disease/treatment vs. monitoring for recurrence.
  • Solid tumors vs. lymphoma vs. leukemia.
  • Primary vs. secondary (metastatic).
  • Documentation examples for proper ICD-10-CM code assignment.

Presenter: Marlana R. Tice, BA, CCS-P, CPC, CCS,
AHIMA-Approved ICD-10-CM/PCS Trainer, Program Director,
Risk Adjustment-HCC Coding Education, UPMC Health Plan

Register now. This webinar will be recorded.

Certified coders may earn 1.0 CEU from the American Academy of Professional Coders (AAPC).

This activity has been designated as and meets the Pennsylvania licensure requirement for Patient Safety-Risk Management Credit. It is the responsibility of the learner to maintain the educational presentation or conference agenda as evidence, if needed for audit purposes.

You may earn continuing medical education (CME) credits for attending this webinar. This activity is approved for AMA PRA Category 1 Credit™ and ANCC. Other health care professionals will receive a certificate of attendance confirming the number of contact hours commensurate with the extent of participation in this activity.

Provider is responsible for verifying CME eligibility.
02/2024CME webinar: Heart Failure and Success in Medication Optimization (recorded)
This recorded webinar will educate providers on:
  • Updated classifications and definitions of heart failure per the 2022 AHA/ACC/HFSA Guidelines for Management of Heart Failure.
  • Current guidelines for directed medical therapies.
  • Practical components of initiating and uptitrating heart failure medications.
  • Case studies from Medication Optimization Clinic.

Presenters:
  • Gavin W Hickey, MD, Assistant Professor at University of Pittsburgh School of Medicine; Medical Director, VAD Program, UPMC Heart and Vascular Institute; Program Director, UPMC Advanced Heart Failure/Transplant and Pulmonary Hypertension Fellowship Program
  • Jennifer Kliner, CRNP, Supervisor, UPMC Heart and Vascular Institute, Advanced Heart Failure and Pulmonary Hypertension Program; Regional Director, Heart Failure Medication Optimization Clinics; Program Coordinator, Comprehensive Pulmonary Hypertension

Watch now
02/2024Voluntary nationwide recall: Zenzedi (Azurity – January)
Azurity Pharmaceuticals Inc. is recalling one lot of Zenzedi tablets, USP 30 mg. Zenzedi is used for the treatment of narcolepsy (a sleep disorder) and attention deficit hyperactivity disorder (ADHD).

This drug is being recalled because tablets of Carbinoxamine Maleate, an antihistamine drug, were found in a Zenzedi bottle during pharmacy dispensing. Patients who take carbinoxamine instead of Zenzedi® will experience undertreatment of their symptoms, which may result in functional impairment and an increased risk of accidents or injury. Administration of Carbinoxamine may cause adverse events which include, but are not limited to, drowsiness, sleepiness, central nervous system (CNS) depression, increased eye pressure, enlarged prostate urinary obstruction, and thyroid disorder.

As of the date of Azurity’s recall announcement, Jan. 24, 2024, there have been no reports of adverse events related to this recall. To see if your medication was recalled, contact your doctor or pharmacy where you received the medication or visit the FDA website below.

If you have an affected lot of Zenzedi, you should stop using the item and return it to the place of purchase.

To learn more about this recall, you can take one or more of the steps below.
  • Talk to your doctor or pharmacist.
  • Call Inmar Intelligent at 1-877-804-2069. TTY users should call 711. Help is available Monday through Friday from 9 a.m. to 5 p.m. EST.
  • Visit the FDA website.

01/2024 CME webinar: Supporting Intimate Partner Violence Survivors and Their Children in Health Care Settings
Please join us for a live, CME-accredited webinar on Wednesday, March 20, from noon to 1 p.m. The webinar will provide an overview of how to support intimate partner violence (IPV) survivors and their children in health care settings.

During this presentation, our expert will:
  • Review the prevalence of IPV and how it is impactful to caregivers and children.
  • Discuss how to address IPV in health care settings through healing-centered approaches.
  • Examine how to support IPV survivors, particularly through connection with local victim services agencies.

Presenter:
Maya I. Ragavan, MD, MPH, MS, Assistant Professor of Pediatrics, Public Health, and Clinical and Translational Science Associate Vice Chair, Diversity Equity and Inclusion Research, Department of Pediatrics Associate Core Director, Clinical and Translational Science Institute Community PARTners Core University of Pittsburgh and UPMC Children’s Hospital of Pittsburgh

Register now.

This webinar will be recorded.

This activity is approved for AMA PRA Category 1 Credit™ and ANCC. Other health care professionals will receive a certificate of attendance confirming the number of contact hours commensurate with the extent of participation in this activity.

Provider is responsible for verifying CME eligibility.
01/2024CME webinar: Antimicrobial Stewardship in Outpatient Settings
Please join us for a live, CME-accredited webinar on Wednesday, Feb. 28, from noon to 1 p.m. The webinar will provide an overview of antimicrobial stewardship in outpatient settings. During this presentation, experts will:
  • Review core concepts of antimicrobial resistance and antimicrobial stewardship.
  • Identify communication strategies to improve patient-provider discussions about antibiotics.
  • Discuss antimicrobial stewardship initiatives at the Pennsylvania Department of Health.
    • Presenters:
    • Will Phillips, MPH, Associate Epidemiology Specialist, Healthcare Associated Infection Prevention Division at the Pennsylvania Department of Health
    • Mary E. Kelleher, MD, MPH, Senior Medical Director Medicaid, UPMC Health Plan
    Register now. This webinar will be recorded. This activity is approved for AMA PRA Category 1 Credit™ and ANCC. Other health care professionals will receive a certificate of attendance confirming the number of contact hours commensurate with the extent of participation in this activity.
    Provider is responsible for verifying CME eligibility.
01/2024Voluntary nationwide recall: Sodium Bicarb and Atropine (Hospira – December)
Hospira Inc. is recalling several lots of 4.2% Sodium Bicarbonate Injection, USP, 8.4% Sodium Bicarbonate Injection, USP, and Atropine Sulfate Injection, USP. Sodium Bicarbonate is used for the treatment of metabolic acidosis (a buildup of acid in the body). Atropine Sulfate is used for temporary blockade of severe or life-threatening muscarinic effects (effects on certain nerves of the body).
These drugs are being recalled because particles of glass were found in the drug(s) during a routine inspection of samples. Administration of an injectable product that contains particulate matter may result in local irritation or swelling, blockage of blood vessels, or life-threatening blood clot events.
As of the date of Hospira’s recall announcement, Dec. 21, 2023, there have been no reports of adverse events related to this recall. To see if your medication was recalled, contact your doctor or pharmacy where you received the medication or visit the FDA website below. If you have an affected lot of Sodium Bicarbonate Injection or Atropine Sulfate Injection, you should stop using the item and return it to the place of purchase or discard it. To learn more about this recall, you can take one or more of the steps below.
  • Talk to your doctor or pharmacist.
  • Call Sedgwick Inc. at 1-800-805-3093. TTY users should call 711. Help is available Monday through Friday from 8 a.m. to 5 p.m. EST.
  • Visit the FDA website.

Expand All Collapse All

2023 Announcements

07/2023COVID-19 PHE
The COVID-19 public health emergency ended on May 11. Appendix A has been updated to reflect the end date for specific benefits and coverage for UPMC Health Plan products. You can refer to our policies and procedures manual for other coverage-related matters.

If you have any questions, please contact your physician account executive or call Provider Services at 1-866-918-1595.
12/2023Musculoskeletal procedures update
Effective Feb. 1, 2024, UPMC Health Plan will begin requiring prior authorizations for certain musculoskeletal procedures, which will be evaluated using corresponding Interqual Connect criteria. Those procedures, and the associated procedure codes, are:
  • Arthrodesis or Arthroplasty, Interphalangeal Joint, Second-Fifth Toes
    • CPT codes: 28285, 28286
  • Arthroscopy or Arthroscopically Assisted Surgery, Wrist
    • CPT codes: 25628, 25685, 25695, 29843, 29844, 29845, 29846, 29847
  • Arthroscopy, Surgical, Ankle
    • CPT codes: 29891, 29892, 29894, 29895, 29897, 29898, 29904, 29905, 29906, 29907
  • Arthrotomy, Wrist
    • CPT codes: 25040, 25101, 25105, 25107, 25115, 25118, 25119, 25608, 25609, 25645, 25670, 25676
  • Osteotomy, Distal Transpositional, First Metatarsal (MT) (Bunionectomy)
    • CPT codes: 28296, 28299
  • Osteotomy, Proximal, First Metatarsal (MT) (Bunionectomy)
    • CPT codes: 28295, 28297, 28298
  • Plantar Fascial Release
    • CPT codes: 28008, 28060, 28062, 28250, 29893
  • Reduction and Fixation, Radius +/- Ulna Shaft
    • CPT codes: 25500, 25505, 25515, 25520, 25525, 25526, 25530, 25545, 25560, 25565, 25574, 25575

Authorization coding documentation is available at upmchp.us/PriorAuth as well as the auth entry/inquiry page on Provider OnLine. If you have any questions or concerns about this matter, please contact your physician account executive or call Provider Services at 1-866-918-1595.

Providers are responsible for appropriate billing of services. These suggested codes are not meant to provide or supersede clinical judgment. An authorization is not a guarantee of payment for services rendered.
12/2023New in 2024 for UPMC for Life members: Three-month supply to allow up to 100 days of medication
For all UPMC for Life plans with Part D coverage starting Jan. 1, 2024, retail and mail-order three-month supplies will be extended to allow up to 100 days of medication for UPMC for Life members. This change applies to all formulary tiers except Tier 5 (specialty drugs), which is limited to 30 days.

What this means for you
When you are writing a 3-month prescription you can now write it for up to 100 days instead of up to 90 days.

What this means for UPMC for Life members
Members will pay the same copay for a 100-day supply as a 90-day supply and can still fill prescriptions for 90 days if they choose. Members should contact their doctor about updating their prescriptions to a 100-day supply to take advantage of this new benefit. The extension can help members avoid additional trips to the pharmacy–which can help with their concerns about cold/flu season, COVID-19, bad weather, or overcrowded waiting areas.

We hope this change will help our members save money and stay consistent in taking their medication.
12/2023Review our commercial product billing guide
Pennsylvania Act 1 of 2023, signed into law this May, requires insurance policies to cover all costs associated with one supplemental breast screening every year for women with increased risk of breast cancer via MRI or ultrasound.

To assist providers in navigating this new law, we are offering recommendations as a guide to aid with compliance.

We encourage you to review our commercial product billing guide for recommendations around complying with Pennsylvania Act 1 of 2023.

If you have any questions or concerns, please contact your physician account executive or call Provider Services at 1-866-918-1595.
12/2023Coming soon: LGBTQIA+ Affirming Provider Designation toolkits
In the coming weeks, we will send the LGBTQIA+ Affirming Provider Designation toolkits to providers who have earned the designation to date. These kits include a provider welcome letter, postcard, badge reel, lapel pin, table tent, and talking points for office staff. Please note that this shipment requires a signature for delivery.

Interested in earning the designation?
We encourage all providers to earn the LGBTQIA+ Affirming Provider Designation. To get started, complete these three modules:
12/2023Flu, RSV, and COVID-19 vaccine recommendations: Fall and winter 2023–2024
Flu, RSV, and COVID-19 vaccines are recommended by the Centers for Disease Control and Prevention (CDC) to reduce the risk of serious illness, hospitalizations, long-term health impacts, and death.

The CDC recommends an annual influenza vaccination for everyone 6 months old and older in the United States.

The agency also recommends an updated COVID-19 vaccine for the 2023–2024 respiratory viral season. Updated vaccines include Pfizer-BioNTech, Moderna, and Novavax COVID-19 vaccines. Everyone 5 years old and older should get one dose of an updated COVID-19 vaccine to be up to date and protected against serious illness from COVID-19. Children 6 months to 4 years old need multiple doses of a COVID-19 vaccine to be up to date, including at least one dose of the updated vaccine. People who are moderately or severely immunocompromised may get additional doses of an updated COVID-19 vaccine.

Single-dose RSV vaccines—Abrysvo and Arexvy—are available for adults 60 years old and older using shared clinical decision making. Additionally, Abrysvo is recommended for individuals who are 32 to 36 weeks pregnant, using seasonal administration, to prevent RSV lower respiratory tract infection in infants.

Specific to pediatrics, children younger than 8 months old who were born during or are entering their first RSV season are recommended to receive one dose of Beyfortus (nirsevimab) (50 mg for infants <5 kg and 100 mg for infants ≥5 kg). Children 8 months to 19 months old who are at increased risk of severe RSV disease and are entering their second season are recommended to receive one 200 mg dose of Beyfortus (nirsevimab).

Visit the CDC website for more information about the flu, RSV, and COVID-19 vaccines:
UPMC Health Plan updates the benefit status of vaccines as information is published by clinical and regulatory groups, such as ACIP, CDC, CMS, USPSTF, and AAP, and will follow all published requirements in a timely manner. Member cost share may be applied in certain circumstances, such as use of an out-of-network provider or use that does not follow ACIP recommendations. Patients should refer to the UPMC Health Plan member website for a full list of participating pharmacies and/or contact Member Services for assistance in determining coverage for various vaccines.

The provider of care is ultimately responsible for providing accurate and compliant information on all submission of claims and/or billing information.
12/2023Mandatory training for Medicare SNP providers
The Centers for Medicare and Medicaid Services (CMS) require all Medicare Special Needs Plan (SNP) providers to complete the Model of Care (MOC) Training every year. The MOC describes the structure and process by which health care services are delivered to SNP members.

For your convenience, UPMC Health Plan has developed a brief online training module on the MOC for our SNP product, UPMC for Life Complete Care (HMO-SNP) (formerly known as UPMC for Life Dual).

To complete the training, go to upmchp.us/snpmoc You will need your tax identification number to sign in and need to attest to completing the training.

Please note that this training must be completed by Feb. 29, 2024.

If you have any questions or concerns, feel free to contact your physician account executive or call Provider Services at 1-866-918-1595.

Thank you for your continued support and the care you provide for our members!
12/2023CME webinar: ADHD Practice Guidelines
Please join us for a live, CME-accredited webinar on Wednesday, April 17, from noon to 1 p.m. The webinar will provide an overview of ADHD practice guidelines and is being offered as part of the UPMC Health Plan Pediatric Collaborative Call series.

During this presentation, experts will discuss:
  • Familiarizing the prescriber with a variety of common problems and solutions in the diagnosis and treatment of ADHD in children and adolescents.
  • Information about the ADHD HEDIS® Quality Metrics.
  • Essential ADHD pharmacy related insights and the UPMC Health Plan resources to health care professionals engaged in prescribing ADHD medications.

Presenters:
  • Craig Coleman, MD, Assistant Professor of Psychiatry, University of Pittsburgh School of Medicine; Attending Psychiatrist, UPMC Western Wellness​, UPMC Behavioral Health of the Alleghenies, CCP Children’s TIPS
  • Debra Zeh, RN, BSN, Senior Director Quality Improvement, Provider Performance​, UPMC Health Plan​
  • Erin McConnell, PharmD, Senior Program Manager,​ Clinical Pharmacy,​ UPMC Health Plan

Register for the ADHD Practice Guidelines Webinar now. This webinar will be recorded.

You may earn continuing medical education (CME) credits for attending this webinar. This activity is approved for AMA PRA Category 1 Credit™, ANCC, ASWB, and ACPE. Other health care professionals will receive a certificate of attendance confirming the number of contact hours commensurate with the extent of participation in this activity.

HEDIS® The Healthcare Effectiveness Data and Information Set (HEDIS®) is a registered​ trademark of NCQA.
11/2023Prescription for Wellness order set updates
Effective Nov. 29, 2023, the Prescription for Wellness order set will be updated to include the following enhancements:
  • Addition of a “Diabetes & Metabolic Health” category that includes following topics:
    • Certified Diabetes Care & Education Specialist – Nurses will engage with members to establish condition-based knowledge and educate on symptom management, medication, and self-care.
    • Diabetes Health Coaching – Health coaches provide longitudinal coaching support to address lifestyle skills and behaviors associated with prevention and management of diabetes and other chronic conditions.
    • Diabetes Prevention Program – Designed to support individuals who are at a higher risk for developing T2DM in the future based on certain risk factors such as weight and hypertension.
  • Addition of “Employment” as a topic in the Patient/Family Support Services category

For more information on Prescription for Wellness, contact director Jamie Delu at RxforWellness@upmc.edu.
11/2023Voluntary nationwide recall: Eye drops (Rugby – November)
The Harvard Drug Group LLC has recalled certain lots of Rugby brand eye drops because of bacteria found in certain samples of product. The bacteria could cause eye infections that result in partial vision loss or blindness. As of the date of The Harvard Drug Group LLC’s recall announcement, Oct. 31, 2023, there had been three adverse events reported that were related to these listed products. Read the full text of the Rugby brand eye drops recall.
11/2023Voluntary nationwide recall: Eye drops (Leader – November)
Cardinal Heath Inc. has recalled certain lots of Leader brand eye drops. These over-the-counter products are used for temporary relief of burning, irritation, and redness of the eye. The drops are being recalled because of bacteria found in certain samples of the product. The bacteria could cause eye infections that result in partial vision loss or blindness. Read the full text of the Leader brand eye drops recall.
11/2023The 988 Suicide & Crisis Lifeline adds nationwide ASL services for Deaf and Hard of Hearing callers
Pennsylvania implemented the 988 Suicide & Crisis Lifeline last July. Like 911, it is simple to remember. This measure helped make it easier for people to access support during a mental health crisis nationwide.

Support has now expanded to include nationwide American Sign Language (ASL) services for people who are Deaf and Hard of Hearing. Callers who are Deaf, DeafBlind, DeafDisabled, Hard of Hearing, and Late-Deafened can connect directly to a trained 988 Lifeline counselor in ASL using these steps:
  1. Visit 988lifeline.org.
  2. Click the “ASL Now” button.
  3. Follow the prompts.

Direct dialing to 988 from a videophone will be available soon. In the meantime, ASL callers can call 1-800-273-TALK (8255) from their videophone to reach ASL services.
11/2023Provider OnLine improvements coming in early 2024
Provider OnLine is a comprehensive resource that allows participating providers to access valuable information online. Starting in early 2024, the site will begin featuring updates to improve your experience. The first of these are updates to member plan (eligibility) information, and improvement to user set up (security management).

Updates to the features include:
  • Improved search speeds.
  • Improved navigation.
  • Expanded participating network information.
  • Policy-level eligibility views.
  • Simplified screen designs.
  • Usability of information presented.

Log in to explore resources
If you have any questions, please contact your physician account executive or call Provider Services at 1-866-918-1595.

Don’t have a Provider OnLine account?
First-time users can create an account by completing an account administrator application.
11/2023Earn CME credits and support your patients' mental health
Caring for your patients’ physical and mental health needs is essential to their overall well-being. These free continuing medical education (CME) courses centered around mental health aim to help you increase the depth and quality of care you provide:*

Suicide and Depression in the Primary Care Office
  • Get information on the prevalence of depression, suicide, and suicidal thoughts. Learn about the importance of screening for depression and suicide within primary care (including an overview of screening tools), best practices for the treatment of depression (including prescribing practices for antidepressants), preferred pathways for primary care to treat and/or refer patients to best address their behavioral health needs, and behavioral health resources and tools provided by UPMC Health Plan.

This activity is approved for AMA PRA Category 1 Credit™ and ANCC. Other health care professionals will receive a certificate of attendance confirming the number of contact hours commensurate with the extent of participation in this activity.

Suicide Prevention and the 988 National Lifeline
  • Educate yourself on the 988 National Suicide Prevention Lifeline’s 24/7 mental health crisis support and prevention resources so you can increase awareness of the lifeline among patients, families, and communities.

This activity is approved for AMA PRA Category 1 Credit™ and ANCC. Other health care professionals will receive a certificate of attendance confirming the number of contact hours commensurate with the extent of participation in this activity.

*Provider is responsible for verifying CME eligibility.
11/2023Provider diagnosis documentation: Updates to Medicare Risk Adjustment/HCC
Please join UPMC Health Plan’s Risk Adjustment/HCC Coding Education Program Director Marlana Tice for a live, CME-accredited webinar on Wednesday, Jan. 24, from noon to 1 p.m., that will provide an overview on provider diagnosis code documentation. During this presentation, viewers will learn:

  • An understanding of diagnosis documentation and ICD-10-CM coding importance for Medicare Advantage patients.
  • Examples of best practice documentation for diagnoses as it relates to notable CMS changes and updates to many ICD-10-CM codes/HCC in the new Medicare Advantage risk adjustment model.
  • Ways to improve diagnosing, documenting, and reporting codes with better specificity based on ICD-10-CM classification.

Presenter:
Marlana R. Tice, BA, CCS-P, CPC, CCS, AHIMA-Approved ICD-10-CM/PCS Trainer, Program Director, Risk Adjustment-HCC Coding Education, UPMC Health Plan

Register now. This webinar will be recorded.

Certified coders may earn 1.0 CEU from the American Academy of Professional Coders (AAPC).

You may earn continuing medical education (CME) credits for attending this webinar. This activity is approved for AMA PRA Category 1 Credit™ and ANCC. Other health care professionals will receive a certificate of attendance confirming the number of contact hours commensurate with the extent of participation in this activity.

Provider is responsible for verifying CME eligibility.
11/2023Voluntary nationwide recall: Exela Pharma (October)
Exela Pharma Sciences, LLC (Exela) is recalling several lots of 8.4% Sodium Bicarbonate Injection, USP. This drug is used for the treatment of metabolic acidosis (a buildup of acid in the body). This drug (NDC: 51754-5001-04) is being recalled because routine inspection of samples found particles of silicone. Administration of an injectable product that contains particulate matter may result in local irritation or swelling in response to the foreign material. If the particulate matter reaches the blood vessels it can travel to various organs and block blood vessels in the heart, lungs, or brain. The blockage can cause stroke and even lead to death. Read the full text of the Excela Pharma recall.
11/2023Nursing facility ineligible reassessment and certification forms (MA570)
Community HealthChoices patients are required to renew their Community HealthChoices Medicaid eligibility for home- and community-based services in order to continue receiving services and supports in their home rather than needing to receive assistance in an institutional setting such as a nursing facility, ICF/ORC, or other institutional setting. The Pennsylvania Physician Certification Form, also called the MA570, is a required part of the eligibility determination for Community HealthChoices programs.

You may be receiving outreach calls or correspondence from service coordinators, physician account executives, or clinical improvement specialists reminding you that completion of these forms is necessary to prevent delays with your patient’s application. The renewal application requires that the MA570 form be completed in its entirety and signed by an MD or DO. On the form, please remember to indicate your patient’s level of care using the definitions provided on the MA570 form itself. For patients meeting ICF/ORC, page 2 of this form must also be completed. Below is a summary of each available level of care option. It is important to remember that you are only recommending the appropriate level of care for your patient, not determining which setting is most appropriate for them to receive their services.

Nursing Facility Clinically Eligible (NFCE) – The individual has an illness, injury, disability, or medical condition diagnosed by a physician; and as a result of that diagnosed illness, injury, disability, or medical condition, the individual requires care and services above the level of room and board. A physician certifies that the individual is NFCE; and the care and services are either a) skilled nursing or rehabilitation services as specified by the Medicare Program in 42 CFR §§ 409.31(a), 409.31(b)(1) and (3), and 409.32 through 409.35; or b) health-related care and services that may not be as inherently complex as skilled nursing or rehabilitation services, but which are needed and provided on a regular basis in the context of a planned program of health care and management and were previously available only through institutional facilities.

Nursing Facility Ineligible (NFI) – Individuals who do not meet the definition of Nursing Facility Clinically Eligible are considered NFI.

Intermediate Care Facility for Persons with Other Related Conditions (ICF/ORC) – The individual has a diagnosis of Other Related Condition (ORC), a severe, chronic disability (other than a mental illness or an intellectual disability)that manifested before age 22, is likely to continue indefinitely, results in an impairment of either general intellectual functioning or adaptive behavior, and results in substantial functional limitations in at least three of these areas: self-care, understanding and use of language, learning, mobility, self-direction, and capacity of independent living, and requires active treatment—a continuous program that aggressively and consistently gives specialized and generic training, treatment, health services and related services; that focuses on the client acquiring behaviors necessary to function with as much self-determination and independence as possible; and that aims to prevent or slow regression or loss of current optimal functional status.

To prevent delays with your patient’s application, please complete, sign, and return the form to chcscentral@upmc.edu from a secure email or by fax to 1-844-890-7458 as soon as possible, but within 14 days of receipt to avoid any disruption in services or Medicaid eligibility.
10/2023 Voluntary nationwide recall: Betaxolol (KVK – October)
KVK-Tech Inc. is recalling one lot of Betaxolol tablets, USP 10 mg. This drug is used for the treatment of hypertension (high blood pressure).

KVK-Tech Inc. is recalling one lot of this drug (batch number 17853A) as a precautionary measure because a single Oxycodone HCl tablet 5 mg tablet ws found in one batch of the packaging. Betaxolol tablets have a debossed “K” above bisect “13” on one side and plain on the other side, which looks similar to Oxycodone HCL 5 mg tablets. Inadvertent exposure to a controlled substance, such as oxycodone, in specific patient populations is likely to result in significant slowing in breathing, known as respiratory depression, which is a serious health risk.

As of Sept. 29, 2023, there have been no reports of adverse events related to this recall.

Please see the table below to determine if your product has been recalled:

Product name: Betaxolol tablets USP 10 MG (NDC 10702-0013-01)
Lot number: 17853A
Expiry date:06/2027

If you have Betaxolol 10 mg tablets from this lot, you should stop using/return to place of purchase/discard.

To learn more about this recall, you can take one or more of the steps below.
  • Talk to your doctor or pharmacist.
  • Call KVK-Tech Inc. at 215-579-1842 Ext: 6002. TTY users should call 711. Help is available Monday through Friday from 8 a.m. to 6 p.m. EST.
  • Visit the FDA website at upmchp.us/betaxolol-drugrecall.
10/2023 Voluntary nationwide recall: Brexafemme
Scynexis, Inc. is recalling two lots of Brexafemme (ibrexafungerp tablets) due to potential cross-contamination with a nonantibacterial ß-lactam drug substance in the ibrexafungerp citrate used to manufacture the Brexafemme tablets. This drug is used as an antifungal for the treatment of vulvovaginal candidiasis (VVC) and the reduction of the incidence of recurrent vulvovaginal candidiasis (RVVC). Read the full text of the voluntary Brexafemme recall.
10/2023UPMC begins sharing biometric screening results for its new employees with consent
New employees complete a biometric screening as part of UPMC’s hiring process. During the biometric screening they have clinically appropriate titers and total cholesterol, triglyceride, and glucose levels drawn.

Effective September 2023, new UPMC employees may consent to share all preplacement-related lab work with their PCP. PCPs will receive results from Quest Quanum based on their preferred method on file with Quest. Providers without a method on file will receive results via fax.

Employees may consult with their PCP office regarding these test results. Additionally, UPMC Employee Health will offer any recommended vaccinations, health coaching, and other wellness-related services.
10/2023Voluntary nationwide recall: Cyclosporine
Novartis is recalling one lot of Sandimmune Oral solution (cyclosporine oral solution, USP), 100 mg/mL, due to crystal formation observed in some bottles. This drug is used to prevent organ rejection in kidney, liver, and heart transplants. Read the full text of the Cyclosporine recall.
10/2023Voluntary nationwide recall: Sucralfate
VistaPharm LLC has recalled one lot of Sucralfate Oral Suspension, 1 g/10 mL due to Bacillus cereus contamination in the product. This drug is used as an anti-ulcer therapeutic. Read the full text of the Sucralfate recall.
09/2023Drug recall: Voluntary nationwide recall: Digoxin
Marlex Pharmaceuticals Inc. is recalling two lots of this drug because of a label mix-up. Bottles of Digoxin Tablets USP 0.125 mg are incorrectly labeled and contain Digoxin Tablets USP 0.25 mg. Bottles of Digoxin Tablets USP 0.25 mg are incorrectly labeled and contain Digoxin Tablets USP 0.125 mg. This drug is used for the treatment of mild to moderate heart failure. Read the full text of the voluntary Digoxin recall.
09/2023CME webinar: Intimate Partner Violence: Driving Forward Toward Solutions (recorded)
Please make time to listen to this on-demand, CME-accredited webinar on intimate partner violence (IPV)—a global health issue that affects physical and mental health and well-being. Judy C. Chang, MD, MPH, who has dedicated much of her career to sharing strategies and tactics around IPV prevention and interventions, discusses a range of topics around this issue during the webinar.
What the webinar will cover
  • Overview of intimate partner violence (IPV)
  • Impact of IPV on women’s health
  • Lessons learned from the COVID-19 pandemic
  • How we can help women experiencing IPV
Presenter:
Judy C. Chang, MD, MPH
Associate Professor
Departments of Obstetrics, Gynecology and Reproductive Sciences and General Internal Medicine
Assistant Dean of Medical Student Research University of Pittsburgh School of Medicine

Watch now

You may earn continuing medical education (CME) credits for attending this webinar. This activity is approved for AMA PRA Category 1 Credit™ and ANCC. Other health care professionals will receive a certificate of attendance confirming the number of contact hours commensurate with the extent of participation in this activity. Provider is responsible for verifying CME eligibility.
09/2023Drug recall: Voluntary Nationwide Recall: Tydemy (Lupin – July)
Lupin Pharmaceuticals Inc. has recalled two lots of Tydemy™ (Drospirenone, Ethinyl Estradiol and Levomefolate Calcium Tablets 3 mg/0.03 mg/0.451 mg and Levomefolate Calcium Tablets 0.451 mg) because they did not pass stability testing, which could impact the effectiveness of the product. Taking an ineffective product could potentially result in unexpected pregnancy. Read the full text of the voluntary Tydemy recall.
09/2023September is National Recovery Month—earn CME credits on a timely webinar series
September is National Recovery Month, and you are invited to watch a timely, CME-accredited webinar series on the topic. Michael Lynch, MD, FACMT, UPMC Health Plan Quality and Substance Use Disorder Services Medical Director and University of Pittsburgh School of Medicine Associate Professor of Emergency Medicine and Medical Toxicology, leads this four-part series. Watch these recorded webinars to build your knowledge base:
You may earn continuing medical education credits (CMEs) for completing each course.*

*Provider is responsible for verifying CME eligibility.
08/2023Make sure your data is current in the National Plan & Provider Enumeration System
Please review your National Provider Identifier (NPI) data in the National Plan & Provider Enumeration System (NPPES) as soon as possible to monitor that accurate provider data is displayed. Providers are legally required to keep their NPPES data current.

If you have any questions about NPPES, refer to https://nppes.cms.hhs.gov/webhelp/nppeshelp/HOME%20PAGE-SIGN%20IN%20PAGE.html.
08/2023New policy: MP.PA.104
Effective Sept. 15, 2023, UPMC Health Plan will implement a new medical policy: Elective Percutaneous Coronary Intervention (PCI) – MP.PA.104. This is a change from the previously communicated effective date of Sept. 1, 2023, as posted in the August issue of Provider Partner Update. This policy will require prior authorization of PCI services to be considered for reimbursement. View more information on MP.PA.104.
08/2023UPMC Health Plan achieves high ratings in provider satisfaction
In 2022, 95 percent of physician practice survey respondents indicated they would recommend UPMC Health Plan to other physician practices. In addition, respondents ranked UPMC Health Plan in the 95th percentile when comparing UPMC Health Plan to other Health Plans with whom they participate.

UPMC Health Plan contracts with Press Ganey, formerly SPH, to measure provider satisfaction levels and to meet one or more NCQA Health Plan Accreditation Standards. Press Ganey incorporates a percentile ranking to allow health plans to compare performance to a cohort of similar health plans who initiate a provider satisfaction survey.

You may be a randomly selected provider invited to participate in the 2023 survey that will begin this month! The survey will ask for feedback on your experience with UPMC Health Plan. Watch for an invitation in the mail or via email later this month.
07/2023Complete reinstated PROMISe ID enrollment requirements to avoid claim denials for Medical Assistance, CHC, and CHIP
All service locations must comply with the reinstated PROMISe™ ID enrollment requirements to avoid claim denials for patients with UPMC for You (Medical Assistance), UPMC for Kids (Children’s Health Insurance Program/CHIP), and UPMC Community HealthChoices coverage for service dates starting Sept. 1, 2023. Providers who offer, order, refer, or prescribe services for patients with these coverage types must take the following steps to comply with the requirements:
  • Enroll every service location where they see members with the Department of Human Services (DHS).
  • Obtain a PROMISe ID (also known as a Medicaid ID or MPI) and revalidate these locations as required every five years.
  • Log in to PROMISe to check the revalidation dates of each service location and submit revalidation applications at least 60 days prior to the revalidation dates.
  • Enroll any service locations that are not listed in PROMISe.

      • Review Medical Assistance Bulletin 99-21-01 and Medical Assistance Bulletin 99-22-11 to learn more about the reinstatement of provider enrollment requirements.

      Contact DHS with questions on provider enrollment, revalidation, enrollment fees, site visits, and criminal background checks. You can reach DHS at 1-800-537-8862 (option 2, option 4, option 2).
07/2023Recall: Albuterol Sulfate
Cipla US is recalling six batches of Albuterol Sulfate Inhalation Aerosol, 90 mcg (200 Metered Inhalation), manufactured in November 2021. They initiated the recall because of a complaint where leakage was observed through the inhaler’s inhaler valve. This drug is used to treat asthma and to prevent exercise-induced asthma. Read the full text of the Albuterol Sulfate recall.
07/2023New implementation date for Skilled Nursing and Personal Care Shift Services – MA – MP.PA.050.1
We previously communicated in the July Provider Partner Update that effective Aug. 1, 2023, per Pennsylvania DHS, HCPCS T1019 will be discontinued and replaced with the following HCPCS codes and modifiers:
  • G0156 with modifier U7 for pediatric aide services by a non-legally responsible relative
  • G0156 with modifiers U7/SC for pediatric aide services by a legally responsible relative
  • G0156 U7 TT – Services of home health/hospice aide in home health or hospice settings, each 15 minutes (services by a non-legally responsible relative) – extra patient
  • G0156 U7 SC TT – Services of home health/hospice aide in home health or hospice settings, each 15 minutes (services by a legally responsible relative) – extra patient

Please be aware that due to an additional and more recent communication from PA DHS, the implementation date was changed to Oct. 1, 2023 (previously communicated in the July PPU as Aug. 1, 2023).
07/2023UPMC Health Plan achieves high ratings in provider satisfaction
In 2022, 95 percent of physician practice survey respondents indicated they would recommend UPMC Health Plan to other physician practices. In addition, respondents ranked UPMC Health Plan in the 95th percentile when comparing UPMC Health Plan to other Health Plans with whom they participate.

UPMC Health Plan contracts with Press Ganey, formerly SPH, to measure provider satisfaction levels and to meet one or more NCQA Health Plan Accreditation Standards. Press Ganey incorporates a percentile ranking to allow health plans to compare performance to a cohort of similar health plans who initiate a provider satisfaction survey.

You may be invited to participate in the 2023 survey that will begin next month. The survey is provided to a random sampling of primary care network providers and will ask for feedback on your experience with UPMC Health Plan. Watch for an invitation in the mail or via email next month!
06/2023CME webinar: 2023 UPMC for Life Medicare Product Training
Please join us for a live, CME-accredited webinar Tuesday, July 11, from 7 a.m. to 8 a.m., that will provide an overview on Medicare.

During this presentation, our expert will discuss:
  • The difference between Medicare Fee for Service and Medicare Advantage, why Medicare Advantage exists, and where it’s going in the future.
  • The importance of value-based care.
  • UPMC Health Plan’s Medicare Advantage Plan, UPMC for Life.
  • Care managers and what they do, optimizing information flow.
  • Health outcomes, accountability for costs, and why this is a better patient experience.

Presenter:
  • Barbara Kevish MD, AVP, Medicare Medical Services, UPMC Health Plan

Register now. This webinar will be recorded.

You may earn continuing medical education (CME) credits for attending this webinar. This activity is approved for AMA PRA Category 1 Credit™ and ANCC. Other health care professionals will receive a certificate of attendance confirming the number of contact hours commensurate with the extent of participation in this activity.

Provider is responsible for verifying CME eligibility.
06/2023 CME webinar: Fluoride Varnish and the Pediatric Patient – Making It Work for Your Office
Please join us for a live, CME-accredited webinar Wednesday, Aug. 9, from noon to 1 p.m. that will provide an overview of topical fluoride varnish. This webinar is being offered as part of the Pediatric Collaborative Call series.

During this presentation, experts will discuss:
  • How to understand the oral health benefits of fluoride.
  • How applying fluoride varnish can impact the medical office.
  • The future implications of applying fluoride varnish.

Presenters:
  • Richard Celko, DMD, MBA, Chief Dental Officer, UPMC; Adjunct Assistant Professor, University of Pittsburgh School of Dental Medicine
  • Tanya Gayley, BSDH, RDH, PHDHP, EFDA, Dental Care Manager
  • Barbara Hammerschmitt, MPH, RDH, PHDHP, Dental Care Manager
  • Nora Lugaila, BSDH, RDH, PHDHP, Dental Care Manager
  • Rebecca Nagle, MS, BSN, RN CPHQ, Director of Medicaid and CHIP Quality Program
  • Deborah Moss, MD, MPH, FAAP, Professor of Pediatrics, Children’s Hospital of Pittsburgh; Pediatric Medical Director, UPMC Health Plan

Register for the 'Fluoride Varnish and the Pediatric Patient: Making It Work for Your Office' webinar now. This webinar will be recorded.

Provider is responsible for verifying continuing medical education (CME) eligibility.

You may earn continuing medical education (CME) credits for attending this webinar. This activity is approved for AMA PRA Category 1 Credit™ and ANCC. Other health care professionals will receive a certificate of attendance confirming the number of contact hours commensurate with the extent of participation in this activity.
06/2023Continuous coverage unwinding
The continuous coverage unwinding period began on April 1. Medicaid recipients may have questions about their Medicaid eligibility determination.

We developed this FAQ to help you educate patients who have already submitted their renewal.

The goal of this material is to:
05/2023Patients' Medical Assistance and SNAP Benefits Renewal
Effective May 18, 2023, patients' renewal dates for both Medical Assistance and the Supplemental Nutrition Assistance Program (SNAP) benefits will be available in Provider OnLine.

You can access these dates by clicking on the "Eligibility" view on the left navigation panel and entering the member's information in the search function. Dates will be available for both UPMC for You members and UPMC Community HealthChoices participants.

For UPMC for You-credentialed providers, we have also compiled a comprehensive list of your UPMC for You patients who have an upcoming Medicaid and/or SNAP renewal due date. This list is available to you through Provider OnLine under the Reports tab at the site level within the Clinical folder.

We encourage you to use this information to proactively educate your patients about their upcoming renewals to help them avoid a loss in coverage and benefits.

Below are instructions you can provide to your patients on how to complete their Medical Assistance and SNAP renewals on time.

Renewals: (Medicaid and SNAP)
  • COMPASS is the Department of Human Services’ (DHS) online tool to manage benefit information and apply for services. Recipients can complete their renewal by visiting compass.state.pa.us to renew their benefits online.
  • Call the Consumer Service Center for Health Care Coverage at 1-866-550-4355 to renew benefits by phone.
  • Visit their local County Assistance Office (CAO) to renew benefits in person. Receive a renewal packet in the mail. It will explain how to renew Medicaid benefits. Patients should complete the renewal packet and mail it back to their CAO by the due date listed.

If your patients have questions about their renewal, they can call the Statewide Customer Service Center at 1-877-395-8930 or 215-560-7226 in Philadelphia. They can also call the Customer Service Center to ask questions about their benefits or report changes to their contact information, income, and more. The Customer Service Center cannot renew patients' benefits by phone.

Additional important information to share with patients about Continuous Coverage can be found on this flyer or by visiting dhs.pa.gov/PHE/Pages/Stakeholder-Resources.aspx.
05/2023Voluntary nationwide recall: Akorn Operating Company LLC
Akorn Operating Company LLC is initiating a voluntary recall of various within-expiry human and animal products. As a result of a bankruptcy, the firm is removing several products from the market due to the discontinuation of the Quality program, which would result in the company’s inability to assure that products meet the identity, strength, quality, and purity standards. Read the full text of the Akorn voluntary recall.
05/2023Earn CME credits for National Mental Health Month
Caring for your patients’ physical and mental health needs is essential to their overall well-being. These free continuing medical education (CME) courses centered around mental health aim to help you increase the depth and quality of care you provide:*

  • Suicide and Depression in the Primary Care Office
    • Get information on the prevalence of depression, suicide, and suicidal thoughts. Learn about the importance of screening for depression and suicide within primary care (including an overview of screening tools), best practices for the treatment of depression (including prescribing practices for antidepressants), preferred pathways for primary care to treat and/or refer patients to best address their behavioral health needs, and behavioral health resources and tools provided by UPMC Health Plan.
  • Perinatal Psychiatry: Updates for the OB-GYN in a Rapidly Evolving Field
    • Learn about perinatal psychiatry and the impact that COVID-19 has had on maternal mental health, updates in pharmacological management of perinatal depression, and implementing awareness of health care disparities as it relates to perinatal psychiatry.
  • Suicide Prevention and the 988 National Lifeline
    • Educate yourself on the 988 National Suicide Prevention Lifeline’s 24/7 mental health crisis support and prevention resources so you can increase awareness of the lifeline among patients, families, and communities.
  • Pediatric Behavioral Health: Best Practices for Primary Care
    • Enhance your knowledge of pediatric screening for behavioral health issues.

*Provider is responsible for verifying CME eligibility.
04/2023Voluntary medical device correction: Freestyle Libre
Abbott has initiated a voluntary medical device correction for readers that are used as part of the FreeStyle Libre, FreeStyle Libre 14 Day, and FreeStyle Libre 2 Flash glucose monitoring systems. These systems continuously measure the blood glucose levels of individuals with diabetes. Read more about the voluntary medical device correction for Freestyle Libre.
04/2023Recall: Dabigatran
Ascend Laboratories LLC has recalled 10 lots of Dabigatran capsules due to the presence of a nitrosamine, N-nitroso-dabigatran, above the established Acceptable Daily Intake (ADI) level. Dabigatran is a drug used as an oral anticoagulant to lower the risk of stroke and blood clots. Read more about the Dabigatran recall.
04/2023Withdrawal: Makena
On March 7, 2023, Covis Pharma announced that it is withdrawing Makena (hydroxyprogesterone caproate injection; also referred to as 17-OHPC) from the market. This drug is used to reduce the risk of preterm birth in women who are pregnant with one baby and have a history of spontaneous preterm birth. Read more about the Makena withdrawal.
04/2023 Recall: Atovaquone
Camber Pharmaceuticals Inc. is recalling Atovaquone Oral Suspension, USP 750 mg/5 mL, lot #E220182 with an expiration date of 12/2023, due to possible bacterial contamination in the product. This drug is used for the prevention and treatment of a lung infection called Pneumocystis jiroveci pneumonia (PCP) in adults and children 13 years old and older who cannot tolerate other medicines, such as trimethoprim-sulfamethoxazole. Read the full text of the Atovaquone recall.
04/2023Earn the UPMC LGBTQIA+ Affirming Provider designation
The LGBTQIA+ Affirming Provider designation makes it easy for members to find providers who have been trained to create a safe, welcoming patient-provider relationship for LGBTQIA+ patients and validate the LGBTQIA+ patient.

Eligibility
Providers must complete the appropriate learning modules and attestation and be listed in either the UPMC Health Plan Find Care provider directory or the UPMC Health Services Find a Doctor provider directory to earn the designation.

Earning
  • Providers: Complete three learning modules and an attestation. Each learning module is approved for a maximum of 1.0 AMA PRA Category 1 Credits™. These credits also qualify for the patient safety or risk management requirement.
  • Non-UPMC-employed providers: Access the learning modules and attestation on UPMC Health Plan’s patient health resources page.
  • UPMC-employed providers: Access the learning modules and attestation through HR Direct Learning by searching for "Affirmative Communication with LGBTQIA+ Patients & Members."

Encouraging
Providers who earn this designation will receive the following items to let patients know that the provider has earned this important and supportive designation:
  • LGBTQIA+ Affirming Provider badge reel
  • LGBTQIA+ Affirming Provider pin
03/2023CME webinar: Suicide and Depression in the Primary Care Office (recorded)
What the webinar will cover*
  • Information on the prevalence of depression, suicide, and suicidal thoughts and behaviors from a state and national perspective
  • How to incorporate routine screenings for depression and suicide into daily practice
  • A multipronged approach in the treatment for depression and suicide in primary care
  • How to determine when and how to refer to behavioral health services
  • The spectrum of UPMC Health Plan resources that support behavioral health conditions

Presenters:
Geoff Neimark, MD
Chief Medical Officer
Community Care Behavioral Health Organization

Nicholas DeGregorio, MD, MMM, FACP
AVP, Medicaid Medical Services
UPMC Health Plan

Watch now
Watch the recording of the Suicide and Depression in the Primary Care Office webinar.

Provider is responsible for verifying continuing medical education (CME) eligibility.

*This activity is approved for AMA PRA Category 1.5 Credits™ and ANCC. Other health care professionals will receive a certificate of attendance confirming the number of contact hours commensurate with the extent of participation in this activity.
03/2023Recall: Brimonidine
Apotex Corp. is voluntarily recalling six lots of Brimonidine Tartrate Ophthalmic Solution, 0.15%. The drug is used to reduce elevated intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension. This recall is due to cracks that have developed in some of the Brimonidine tartrate ophthalmic solution bottles’ caps. Read the full text of the Brimonidine recall.
03/2023IMPORTANT NOTICE: End of COVID-19 PHE
IMPORTANT NOTICE: The Biden Administration has announced that the COVID-19 PHE is expected to end on May 11, 2023. Some benefits or flexibilities made available during the PHE will expire on that date. UPMC Health Plan will update this Appendix A with more information about expiring benefits prior to the end of the PHE.
03/2023CME webinar: Vaccination Acceptance – Addressing Today’s Challenges
Please join us for a live, CME-accredited webinar Wednesday, May 17, from noon to 1 p.m. that will provide an overview of how to address vaccine acceptance. This webinar is being offered as part of the Pediatric Collaborative Call series.

During this presentation, experts will discuss:
  • The history of vaccine development, effectiveness, and attitudes.
  • Current trends in vaccination rates.
  • The challenge of vaccine hesitancy.

Presenters:
  • Andrew Nowalk, MD, PHD, Associate Professor of Pediatrics, University of Pittsburgh; Clinical Director of Infectious Diseases, UPMC Children’s Hospital of Pittsburgh; Co-Director, Pediatrics Residency Program, UPMC Children’s Hospital of Pittsburgh
  • Mary Ann Rigas, MD, FAAP, Medical Director of Pediatrics, UPMC Cole; President, Pennsylvania Chapter of the American Academy of Pediatrics
  • Todd Wolynn, MD, MMM, IBCLC, CEO—Kids Plus Pediatrics; Advisory Board President, Shots Heard Round the World
  • Deborah Moss, MD, MPH, FAAP, Professor of Pediatrics, Children’s Hospital of Pittsburgh; Pediatric Medical Director, UPMC Health Plan
  • Robert Rutkowski, MD, FAAP, Medical Director, Practice Transformation and Provider Relations, UPMC Health Plan; Co-Lead Physician, UPMC CCP Children’s Community Pediatrics, Shenango
    • Alin Severance, MD, Medical Director, Behavioral Health Services, UPMC Health Plan; Associate Medical Director, Community Care Behavioral Health Organization

Register now. This webinar will be recorded.

You may earn continuing medical education (CME) credits for attending this webinar. This activity is approved for AMA PRA Category 1 Credit™ and ANCC. Other health care professionals will receive a certificate of attendance confirming the number of contact hours commensurate with the extent of participation in this activity.

Provider is responsible for verifying CME eligibility.
03/2023Stimulant medication shortages
UPMC Health Plan has become aware of shortages for generic stimulant medications used to treat attention-deficit/hyperactivity disorder. We wanted to provide details on how your patients (our members) may navigate these shortages since we are not sure how long they will last.

Through outreach, we have learned that most pharmacies have or can acquire brand-name versions of these drugs. If a patient’s pharmacy does not have one of the generic medications listed below, a one-time override for the noted generic’s brand counterpart may be requested by you, your patient, or the patient’s pharmacy. This process is applicable to all lines of business.

  • Amphetamine salts immediate-release tablet, dextroamphetamine-amphetamine immediate-release tablet (generics for Adderall tablet)
  • Dextroamphetamine-amphetamine extended-release capsule (generics for Adderall XR capsule)
  • Methylphenidate extended-release tablet (generics for Concerta tablet)
    • Note: Brand Concerta is preferred on the Statewide Preferred Drug List for Medical Assistance and Community HealthChoices, so an override should not be needed for members with primary coverage through UPMC for You or UPMC Community HealthChoices.

In the case of UPMC Health Plan Commercial members, brand claims may pay without an override but with higher out-of-pocket costs. To avoid this financial burden on our members, please reach out for an override. With the override, the cost for brand would be the same as generic for a Commercial member whose plan does not have a deductible or whose deductible has already been met.

To obtain overrides or to ask questions, providers can call Pharmacy Services at 1-800-979-8762. Pharmacies can call the Pharmacy Help Desk at 1-800-396-4139 and follow the prompts to speak with the Health Plan. Members can call the Member Services phone number on their member ID card.

We understand that this process is time consuming, but our shared goal is member and patient satisfaction. We will continue to monitor the situation and provide updates accordingly.
02/2023Recall: Tirosint
IBSA Pharma Inc. has recalled 27 lots of TIROSINT®-SOL (levothyroxine sodium) Oral Solution because these lots may be subpotent (they have a lower than normal or acceptable potency). Read the full text of the Tirosint recall.
02/2023Listening to and acting on feedback
Our goal is to provide our members with access to high-quality care. As a partner in care, you are key in helping us achieve this goal. Surveys give us actionable information that can help improve our members’ health care experiences and promote a high level of care.

Gathering feedback
Every year, UPMC Health Plan members provide anonymous feedback on their health care experiences in these ways:
  • The Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey for Commercial, Medicaid, Medicare, and CHIP members
  • The Qualified Health Plan Enrollee Experience survey (QHP) for Marketplace members

Marketing accreditation requirements
These surveys are required to maintain ratings and accreditations:
  • National Committee for Quality Assurance (NCQA) accreditation
  • NCQA ratings
  • Centers for Medicare and Medicaid Service (CMS) star ratings

Reviewing the results1
While we know that you provide excellent care to our members, there are always areas for improvement. The answers to these questions from the 2022 CAHPS surveys identify these opportunities.

Case coordination
  • How often did your doctor have your medical records or other information about your care?
  • How often did you get test results as soon as you needed them?
  • How often did someone from your personal doctor’s office follow up with test results?
  • How often did you and your personal doctor talk about all the prescription medicines you were taking?
  • Did you get the help you need from your personal doctor’s office to manage your care among these different providers and services?
  • How often did your personal doctor seem informed and up to date about care you got from specialists?

Getting care quickly
  • When you needed care right away, how often did you get care as soon as you needed?
  • When you made an appointment for a check-up or routine care at a doctor’s office or clinic, how often did you get an appointment as soon as you needed?

Getting needed care
  • How often was it easy to get the care, tests, or treatment that you needed?
  • How often did you get an appointment to see a specialist as soon as you needed?

Annual flu vaccine
  • Have you had a flu shot since July 1?

Find care options
It is important for our members to get the right care at the right time. You can help by encouraging them to use our new text messaging Care Finder program. Members can text “SERVICES” to 478-762 to learn about UPMC AnywhereCare visits, talk to a nurse through the UPMC MyHealth 24/7 Nurse Line, or work with the Prescription for Wellness team to make healthy lifestyle changes.

To view the CAHPS survey for each line of business1, please visit these websites:

As always, thank you for making outstanding care a priority.

1Please note that the CAHPS survey varies slightly depending on the member’s insurance plan. For example, the survey for individual plan members is different from the survey for Medicaid members.

CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).
02/2023EOP emails starting again
Please note, email notifications of new explanation of payments (EOPs) have resumed as of February 6. As previously indicated, there was no interruption in the posting of EOPs and EOPs will continue to be posted on Provider OnLine as they are finalized.
01/2023Recall: Quinapril
Lupin Pharmaceuticals Inc. has recalled four lots of Quinapril Tablets because they contain of a nitrosamine impurity, N-Nitroso-Quinapril, observed in recent testing above the Acceptable Daily Intake (ADI) level. Such impurities may increase the risk of cancer if people are exposed to them above acceptable levels over long periods of time. Read the full text of the Quinapril recall.

2022 Announcements

10/2022COVID-19 booster update
The FDA authorized bivalent formulations of the Moderna and Pfizer-BioNTech COVID-19 vaccines for use as a single booster dose at least two months after completing primary or booster vaccination. Anyone age 12 and older who has gotten the primary vaccination series with or without an additional booster is eligible.

  • The Moderna COVID-19 Vaccine, Bivalent, is authorized for use as single booster dose in individuals 18 years old and older.
  • The Pfizer-BioNTech COVID-19 Vaccine, Bivalent, is authorized for use as a single booster dose in individuals 12 years old and older.

Read more about COVID-19 Bivalent vaccine boosters.

Additionally, you may also visit the CDC to learn how to find a COVID-19 vaccine. Primary vaccinations and boosters for COVID-19 can be given the same day as the annual flu shot, also now available at providers and pharmacies across the Commonwealth.

For the most recent COVID-19 policy and billing updates from UPMC Health Plan, please see these resources:
12/2022Novillus important dates and times
Late December: The Partners Program Gaps in Care (CGMA) system will be updated. You will see membership through Dec. 15.

Dec. 31: You will be able to submit 2022 care gap and service event information to the CGMA until 11:59 p.m. EST.

Jan. 15: You will be able to submit reopened or rejected 2022 care gap and service event information to the CGMA until 11:59 p.m. EST. Service dates in 2023 will not be accepted at this time.

Jan. 16–March 5: The CGMA will be temporarily closed to prepare for the launch of the 2023 CGMA. You will not have access to the application during that time.

March 6: The 2023 CGMA—including 2023 care gaps and member rosters—will be available at 8 a.m. EST.

The delay in the system launch will allow claims received through January to be processed in February. The system will be updated to reflect 2023 gaps and new membership through Jan. 31, 2023.
12/2022Recall: Omnipod 5
Insulet Corporation has recalled the Omnipod 5 system. This device is a tubeless insulin delivery system for use in patients with diabetes.This does not impact the Omnipod 5 Pod, the Omnipod® DASH Insulin Management System, the Omnipod® Insulin Management System, or compatible Android smartphone devices that have the Omnipod 5 App installed. Read the full text of the Omnipod 5 recall.
11/2022New tip sheet available for the Behavioral Health HEDIS measure: Follow-Up Care for Children Prescribed ADHD Medication (ADD)
The ADD HEDIS® measure outlines the importance for members 6 to 12 years old who are newly prescribed a medication for ADHD to receive, at minimum, three appointments—an initial appointment with the prescriber and subsequent appointments with the treatment team, including behavioral health treatment providers—within 10 months of starting the new medication. The tip sheet defines the HEDIS measure and offers providers tips to ensure continuity of care for their patients who are prescribed medications for ADHD for the first time. Learn more about the ADD HEDIS measure.

HEDIS®
The Healthcare Effectiveness Data and Information Set (HEDIS®) is a registered trademark of NCQA.
11/2022Recall: Sodium Bicarbonate
Exela Pharma Sciences LLC (Exela) has recalled 49 lots of Sodium Bicarbonate Injection, USP, 8.4%, 50 mEq/50 mL vial. This drug is used to treat a condition where there is too much acid in the body fluids. The product is packaged in a 50 mL glass vial. Read the full text of the Sodium Bicarbonate recall..

11/2022UPMC for Kids has expanded into seven additional Pennsylvania counties
UPMC for Kids, UPMC Health Plan’s Children’s Health Insurance Program (CHIP) plan, has expanded into seven additional counties across Pennsylvania to include Bucks, Carbon, Columbia, Delaware, Monroe, Montgomery, and Philadelphia. Effective Dec. 1, 2022, comprehensive high-quality health insurance coverage is available to even more children and teens throughout the state.

Pennsylvania’s Children’s Health Insurance Program (CHIP) is available to all uninsured children and teens (up to age 19). Regardless of family income, every uninsured child and teen who is not eligible for Medical Assistance can have comprehensive health insurance.

Applying for CHIP is easy, and our dedicated UPMC for Kids team can help. A parent or legal guardian can apply for CHIP for their child(ren) by calling us at 1-800-978-8762 (TTY: 711) Monday through Friday from 8 a.m. to 6 p.m. They can also apply online by visiting the state COMPASS website at compass.state.pa.us.

For more information on UPMC for Kids, contact your physician account executive or network manager, or call UPMC for Kids Provider Services at 1-800-650-8762 (option 2) Monday through Friday from 8 a.m. to 5 p.m. You can also find additional information about UPMC for Kids on Provider OnLine at upmchealthplan.com/providers or the UPMC for Kids website at upmchealthplan.com/coverage-for-kids.

Note: All in-network providers who render, order, refer, or prescribe items or services to CHIP members are required to have a valid PROMISe™ ID (also known as MMIS provider ID) from the state of Pennsylvania. A provider must register for a PROMISe ID at each service location where he or she provides services to CHIP enrollees. To apply for a PROMISe ID, enroll additional service locations, or check the status of your application, visit provider.enrollment.dpw.state.pa.us.
11/2022Recall: Quinapril-Hctz
Aurobindo Pharma USA Inc. has recalled two lots of quinapril and hydrochlorothiazide tablets due to detection of a nitrosamine (N-nitrosoquinapril) impurity in amounts above the Acceptable Daily Intake level. Nitrosamines may increase the risk of cancer if people are exposed to them above acceptable levels over long periods of time. Read the full text of the Quinapril-Hctz recall.

11/2022Heart catheter authorization update
Please be advised of the change effective Sept. 20, 2022, to authorizations regarding the following heart catheter code(s):
  • Right heart catheter CPT 93456 no longer requires an authorization.
  • Left heart catheter CPT 93452 no longer requires an authorization.

If you have any questions, contact UPMC Utilization Management at 1-800-425-7800.
11/2022CME webinar: 988 Suicide and Crisis Lifeline (recorded)
What the webinar will cover*
Pennsylvania and its approach to 988 will:
  • Provide medical professionals with information and data related to suicide
  • Offer background on the National Suicide Prevention Lifeline, a national toll-free resource for anyone to call during a mental health crisis, including its new 988 phone number that gives Pennsylvanians access to 24/7 crisis support.
  • Educate providers on the lifeline’s support, prevention, and crisis resources.
  • Highlight the importance of educating patients, families and communities about the lifeline.

Presenters:
  • Matthew B. Wintersteen, PhD, Associate Professor, Director of Research, Thomas Jefferson University/Jefferson Medical College, Department of Psychiatry & Human Behavior
  • Alin Severance, MD, Medical Director, Behavioral Health Services, UPMC Health Plan; Associate Medical Director, Community Care Behavioral Health Organization


Watch now
Watch the recording of the 988 Suicide and Crisis Lifeline webinar

Provider is responsible for verifying CME eligibility.

*This activity is approved for AMA PRA Category 1 Credit™ and ANCC. Other health care professionals will receive a certificate of attendance confirming the number of contact hours commensurate with the extent of participation in this activity.
10/2022Pennsylvania DOH issues poliovirus health advisory and recommendations
The Pennsylvania Department of Health (DOH) is alerting health care providers, laboratories, infection control specialists, and local health departments about these matters regarding poliovirus infection and detection reported in July 2022 in Rockland County, New York:
  • An unvaccinated adult with poliovirus infection and acute flaccid paralysis.
  • Wastewater detection in adjacent counties.

DOH recommendations
The Pennsylvania DOH is urging health care providers to consider polio as a possible cause of sudden onset of limb, facial, oropharyngeal, or respiratory muscle weakness. This consideration is especially important for:
  • People who are not vaccinated against polio.
  • People who are under-vaccinated for polio and have traveled to areas with higher risk of polio or who have had contact with such persons.

If you have a clinical suspicion for a case of polio after evaluating a patient, you should contact your local or state health department to discuss the case and to determine testing. The DOH also recommends that you immediately identify and schedule appointments for patients in your practice who are not up to date on the poliovirus vaccine.

Learn more
Review the Pennsylvania DOH health advisory to learn more about poliovirus infection, detection, and prevention.
Questions?

If you have any questions, please call the Pennsylvania DOH at 1-877-PA-HEALTH (1-877-724-3258) or your local health department.
10/2022Mandatory Training for Medicare SNP Providers
The Centers for Medicare & Medicaid Services (CMS) require all Medicare Special Needs Plan (SNP) providers to complete the Model of Care (MOC) Training every year. The MOC describes the structure and process by which health care services are delivered to SNP members.

For your convenience, UPMC Health Plan has developed a brief online training module on the MOC for our SNP product, UPMC for Life Complete Care (HMO-SNP), formerly known as UPMC for Life Dual.

To complete the training, go to upmchp.us/snpmoc. You will need your tax identification number to sign up.

If you have any questions or concerns, contact your physician account executive or call Provider Services at 1-866-918-1595.

Thank you for your continued support and the care you provide for our members!
10/2022Thank you for helping UPMC for Life earn an excellent 5 out of 5 stars AGAIN!
We are proud to announce that UPMC for Life earned an excellent 5 out of a possible 5 overall star rating for our HMO and PPO plans for 2023 from Medicare. UPMC for Life is the largest HMO plan in Pennsylvania with a 5-star rating. This perfect 5 out of 5-star rating is something that only the highest quality Medicare Advantage plans in the nation receive.

Additionally, UPMC for Life received National Committee for Quality Assurance (NCQA) Accreditation. This makes UPMC for Life the ONLY plan in PA to have achieved NCQA Accreditation and a 5-star rating from Medicare for both our HMO and PPO products.

UPMC for Life is simply THE BEST—thanks in large part to you! We could not have earned these important accomplishments without your contributions and continued partnership. Thank you for your dedication to bringing excellence and service to our more than 200,000 Medicare members. This reflects the strength and stability of the UPMC for Life products and our pledge to help our members live their fullest, healthiest lives. In fact, UPMC for Life has an excellent member retention rate of 96% for its Medicare plans over the last year. We appreciate all you do to provide the best possible care for our members.

These prestigious achievements are based on how well we deliver medical coverage, prescription drug coverage, customer service, and satisfaction to our members. They measure our quality and performance compared to other Medicare plans. This is truly an honor that we all should be proud of.

We hope these ratings resonate with your UPMC for Life patients as we continue to work together to provide the best possible member experience.

Thank you for your contributions.
10/2022CME Webinar: Pediatric Collaborative Call—Addressing Health Disparities: Impact on Maternal and Pediatric Health
Please join us for a live, CME-accredited webinar Wednesday, Nov. 16, from noon to 1 p.m. The presentation will include an overview of how to address health disparities, including:
  • Understanding the difference between health equity and health equality.
  • Recognizing key maternal and pediatric health disparity trends.
  • Defining social determinants of health.
  • Understanding the role providers, health plans, health systems, and communities have in recognizing health disparities and resources to improve those outcomes.

Presenters:
  • Johanna Vidal-Phelan, MD, MBA, FAAP, Chief Medical Officer – Quality Department UPMC Insurance Services Division; Clinical Assistant Professor of Pediatrics University of Pittsburgh School of Medicine
  • Katie Domalakes, MSW/LSW, Senior Director Clinical Affairs and Program Development, UPMC for You and UPMC for Kids, UPMC Health Plan
  • Elana Glick, MPH, CPH, MCHES, NBC-HWC, Director, Clinical Programs Health Management, UPMC Health Plan
  • ebra Zeh, RN, BSN, Senior Director of Quality Provider Performance, UPMC Health Plan


Register now. This webinar will be recorded.

You may earn continuing medical education (CME) credits for attending this webinar.*

*This activity is approved for AMA PRA Category 1 Credit™ and ANCC. Other health care professionals will receive a certificate of attendance confirming the number of contact hours commensurate with the extent of participation in this activity.

Provider is responsible for verifying CME eligibility.
9/2022Cotiviti collaboration aims to prevent payment errors and improve the reimbursement process
This month, UPMC Health Plan began collaborating with Cotiviti Inc. after its acquisition of Health Management Services’ payment integrity solutions. The collaboration is for the following periodic post-payment reviews of paid medical claims, which are similar to reviews previously conducted by Health Management Services:
  • Retrospective Accuracy (RA) reviews. Cotiviti uses data from paid claims to conduct these reviews that help ensure appropriate coding. These reviews do not require additional documentation from the provider.
  • Clinical Claim Validation (CCV) reviews. In these cases, Cotiviti reviews medical records to ensure appropriate billing. If a claim is identified for a CCV review, the provider will receive a letter that:
    • Identifies the selected the claim(s).
    • Requests detailed information on the selected the claim(s), including a required copy of the medical records, if UPMC Health Plan has not already received these medical records. Outlines the response guidelines and time frames.

If you have any questions, please contact UPMC Health Plan’s Provider Services team at 1-866-918-1595. The team is available Monday through Friday, 8 a.m. to 6 p.m. (EST).
9/2022Medicaid implementation/Member enrollment reminder
Please be aware that questions regarding PA Medicaid enrollment and eligibility are addressed by the Pennsylvania Department of Human Services (DHS) and cannot be answered directly by UPMC Health Plan Provider Services.

If you are a provider receiving patient inquiries regarding Medicaid plan enrollment or MCO plan changes, please direct these Medicaid-covered individuals to the following resources:
  • Pennsylvania enrollment site
  • Toll-free number: 1-800-440-3989
    TTY: 1-800-618-4225
    Hours of operation: Monday – Friday, 8 a.m. – 6 p.m.

9/2022Monkeypox update
Monkeypox is a rare infectious disease caused by the monkeypox virus. Although we are seeing an outbreak of cases across the U.S. and the world this summer, it remains rare. The illness associated with monkeypox can include fever, fatigue, body aches, and swollen lymph nodes. The most prominent feature of the illness is a rash, which can occur with or without the other symptoms. The rash starts as spots that progress to fluid-filled bumps and eventually break open and leave a scab. Monkeypox is spread by close contact with an infected individual. This close contact can be during sexual activity, but monkeypox is not a sexually transmitted infection.

Vaccines and treatments for monkeypox are available in the community and may be recommended for those who have tested positive or had close, prolonged contact with an infected individual. If you have further questions about monkeypox, you can find more information at cdc.gov/poxvirus/monkeypox/clinicians/index.html.
9/2022CME webinar: Screening and Assessment for Suicide Prevention
September is National Suicide Awareness Month, and you are invited to watch a timely recorded webinar on the topic. Andrei Nemoianu, MD, Regional Medical Director, Community Care Behavioral Health Organization, discusses:
  • How to define suicide screening and identify how often it should be used.
  • Suicide assessment and when it should be done.
  • How to gain greater familiarity with formulating a suicide risk assessment.
  • Three suicide screening tools.
  • How to locate resources to help develop a policy around suicide screening and assessment.
Register or log in to listen to the webinar. You may earn continuing medical education credits (CME) for watching this webinar.*

*This activity is approved for AMA PRA Category 1 Credit™ and ANCC. Other health care professionals will receive a certificate of attendance confirming the number of contact hours commensurate with the extent of participation in this activity.
*Provider is responsible for verifying CME eligibility.

9/2022CME webinar series: Addiction Care for the Non-Addiction Provider
CME webinar series: Addiction Care for the Non-Addiction Provider September is National Recovery Month, and you are invited to watch a timely, CME-accredited webinar series on the topic. Michael Lynch, MD, Medical Director, Pittsburgh Poison Center; Medical Director, UPMC Health Plan Substance Use Disorder Services; and Associate Professor of Emergency Medicine, Toxicology, Pediatrics, and Addiction at the University of Pittsburgh, leads this four-part series. Watch these recorded webinars to build your knowledge base: You may earn continuing medical education credits (CMEs) for completing each course.*
*Provider is responsible for verifying CME eligibility. *This activity is approved for the following credit: AMA PRA Category 1 Credit™ and ANCC. Other health care professionals will receive a certificate of attendance confirming the number of contact hours commensurate with the extent of participation in this activity.
9/2022Earn the UPMC LGBTQIA+ Affirming Provider designation!
UPMC Health Plan has established the LGBTQIA+ Affirming Provider designation to make it easy for members to find providers who can communicate and validate LGBTQIA+ patient experiences and create a safe and welcoming patient-provider relationship for LGBTQIA+ patients. This designation is an indicator of a provider’s cultural competency.

To be eligible for the LGBTQIA+ Affirming Provider designation, providers must be listed in either the UPMC Health Plan Find Care provider directory or the UPMC Health Services Find a Doctor provider directory.

The designation will be visible to patients and members in the directories this summer or fall.

Providers can earn the LGBTQIA+ Affirming Provider designation now by completing three learning modules and an attestation. Each learning module is approved for a maximum of 1.0 AMA PRA Category 1 Credits™.

Non-UPMC employed providers can access the learning modules and attestation on UPMC Health Plan’s patient health resources page.

UPMC-employed providers can access the learning modules and attestation through HR Direct Learning by searching for "Affirmative Communication with LGBTQIA+ Patients & Members."
8/2022New 988 Suicide and Crisis Lifeline Offers Pennsylvanians Easy Access to Mental Health Crisis Support 24/7
Implemented on July 16, 2022, the new 988 National Suicide Prevention Lifeline number is the result of legislation that provides federal support, guidance, and funding to states to enact 988 and crisis services, giving those in mental health crises easy access to behavioral support.

All states are required to enable this number as a quick option that:
  • Provides everyone with one simple pathway to reach out for help when thoughts of suicide or other increased mental health symptoms arise.
  • Allows those with mental health crisis training and education and those knowledgeable about mental health resources within the caller’s community to respond appropriately.

988 is now active in Pennsylvania and like 911, it is simple to remember. Health care providers can advise patients to call 988 anytime they are experiencing a mental health or substance use crisis.

How it works in PA
Anyone experiencing a mental health crisis can call or text 988 to access support 24 hours a day, seven days a week. Those who need mental health crisis support can also use the chat feature on the 988 website. The chat feature is an important option for those who speak Spanish and for those who are deaf or hard of hearing.

When someone calls the lifeline:
  1. The 988 number connects them to the National Suicide Prevention Lifeline, which answers calls via the new 988 number or through its existing 10-digit phone number, 1-800-273-8255.

    Note: Callers will also be given the option to reach the Veterans Crisis Line (Option 1) or a Spanish speaker (Option 2).
  2. They are connected with a mental health crisis service provider in their area.
  3. People can then receive telephonic crisis services or, when/where applicable, have mobile crisis services dispatched directly to them.

Learn more
Providers may reference the 988 SAMHSA Partner toolkit, which includes 988 fact sheets in English and Spanish, and other printable materials or learn more by visiting dhs.pa.gov/Services/Mental-Health-In-PA/Pages/988.aspx.
8/2022Recall: Magnesium Citrate
Vi-Jon LLC has recalled all lots of all flavors of Magnesium Citrate Saline Laxative Oral Solution, 10 fl oz. (296mL) within their expiration date. This drug is used to treat occasional constipation and generally produces a bowel movement in 0.5 to 6 hours. The product is packaged in a 10-oz. clear round plastic bottle. Read the full text of the Magnesium Citrate recall.

8/2022UPMC Health Plan achieves high ratings in provider satisfaction
In 2021, 95 percent of physician practice survey respondents indicated they would recommend UPMC Health Plan to other physician practices. In addition, respondents ranked UPMC Health Plan in the 93rd percentile or higher on 17 of 19 questions in the 2021 Provider Satisfaction Survey.

UPMC Health Plan contracts with Symphony Performance Health (SPH) Analytics to measure provider satisfaction levels and to meet one or more NCQA Health Plan Accreditation Standards. SPH incorporates a percentile ranking to allow health plans to compare performance to a cohort of similar health plans who initiate a provider satisfaction survey.

You may be a randomly selected provider invited to participate in the 2022 survey that will begin later this month! The survey will ask for feedback on your experience with UPMC Health Plan. Watch for an invitation in the mail or via email later this month.
8/2022UPMC for You has been awarded a Medicaid Managed Care Contract for all five Physical HealthChoices zones across the Commonwealth of Pennsylvania
UPMC for You has been awarded a Medicaid Managed Care Contract for all five Physical HealthChoices zones across the Commonwealth of Pennsylvania, currently planned to go live1 on Sept. 1, 2022. A comprehensive training is available online for your reference and participation. You can also review a list of frequently asked questions at upmchp.us/ProviderFAQ. Thank you for your continued support of UPMC for You and the great care you provide to our members. We wouldn’t be at more than a half a million members strong and growing without you!

1Go-live implementation dates and communication timelines are subject to change at discretion of the Pennsylvania Department of Human Services.
7/2022MC Health Plan achieves high ratings in provider satisfaction
In 2021, 95 percent of physician practice survey respondents indicated they would recommend UPMC Health Plan to other physician practices. In addition, respondents ranked UPMC Health Plan in the 93rd percentile or higher on 17 of 19 questions in the 2021 Provider Satisfaction Survey.

UPMC Health Plan contracts with Symphony Performance Health (SPH) Analytics to measure provider satisfaction levels and to meet one or more NCQA Health Plan Accreditation Standards. SPH incorporates a percentile ranking to allow health plans to compare performance to a cohort of similar health plans who initiate a provider satisfaction survey.

You may be invited to participate in the 2022 survey that will begin next month. The survey is provided to a random sampling of primary care network providers and will ask for feedback on your experience with UPMC Health Plan. Watch for an invitation in the mail or via email next month!
7/2022Earn the UPMC LGBTQIA+ Affirming Provider designation!
UPMC Health Plan has established the LGBTQIA+ Affirming Provider designation to make it easy for members to find providers who can communicate and validate LGBTQIA+ patient experiences and create a safe and welcoming patient-provider relationship for LGBTQIA+ patients. This designation is an indicator of a provider’s cultural competency.

To be eligible for the LGBTQIA+ Affirming Provider designation, providers must be listed in either the UPMC Health Plan Find Care provider directory or the UPMC Health Services Find a Doctor provider directory.

The designation will be visible to patients and members in the directories this summer or fall.

Providers can earn the LGBTQIA+ Affirming Provider designation now by completing three learning modules and an attestation. Each learning module is approved for a maximum of 1.0 AMA PRA Category 1 Credits™.

Non-UPMC employed providers can access the learning modules and attestation on UPMC Health Plan’s patient health resources page.

UPMC-employed providers can access the learning modules and attestation through HR Direct Learning by searching for "Affirmative Communication with LGBTQIA+ Patients & Members."
7/2022Recall: Milk of Magnesia
Plastikon Healthcare LLC has recalled 1 lot of Milk of Magnesia 2400 mg/10 mL Oral Suspension, 1 lot of Milk of Magnesia 2400 mg/30 mL Oral Suspension, 11 lots of Magnesium Hydroxide 1200mg/Aluminum Hydroxide 1200 mg/Simethicone 120 mg per 30 mL Oral Suspension, and 2 lots of Magnesium Hydroxide 2400 mg/Aluminum Hydroxide 2400 mg/Simethicone 240 mg per 30 mL Oral Suspension. Read the full text of the Milk of Magnesia recall.
7/2022Recall: Insulin Glargine
Mylan Pharmaceuticals Inc. has recalled one batch of Insulin Glargine (Insulin glargine-yfgn) Injection, 100 units/mL (U-100), 3 mL prefilled pens. Read the full text of the Insulin Glargine recall.
7/2022Recall: Magnesium Citrate
Vi-Jon LLC has recalled one lot of CVS Magnesium Citrate Saline Laxative Oral Solution Lemon Flavor, 10 fl. oz. (296 mL). This drug is used to treat occasional constipation and generally produces a bowel movement in 0.5 to 6 hours. The product is packaged in a 10-oz., clear round plastic bottle. The affected CVS Magnesium Citrate Saline Laxative Oral Solution Lemon Flavor lot includes batch number 0556808 and expiration date 12/2023 (printed on the shoulder of the bottle). Read the full text of the Magnesium Citrate recall.
7/2022Recall: Morphine Sulfate
Bryant Ranch Prepack Inc. is recalling one lot of Morphine Sulfate 30 mg Extended-Release tablets (Comprised of 10 bottles), and one lot of Morphine Sulfate 60 mg Extended-Release tablets (comprised of 10 bottles). This medication is used to treat severe pain. Read the full text of the Morphine Sulfate recall.
7/2022Recall: Zelnorm
Alfasigma USA Inc. will no longer make Zelnorm® available in the U.S. marketplace effective June 30, 2022. This medication is used to treat irritable bowel syndrome with constipation (IBS-C) in adult women younger than 65 years old. Read the full text of the Zelnorm recall.
7/2022CME webinar: Pediatric Asthma Management Guidelines
Please join us for a live, CME-accredited webinar Wednesday, Aug. 24, from noon to 1 p.m. The presentation will include an overview of the latest 2020 Pediatric Asthma Management Guidelines, including:
  • The use of as-needed courses of inhaled corticosteroids in the management of mild persistent asthma.
  • The use of single-inhaler maintenance and reliever therapy (SMART) in moderate persistent asthma.
  • Strategies and potential barriers to the implementation of new asthma management guidelines.
  • Sharing UPMC Health Plan asthma resources.

Presenters:
  • Erick Forno, MD, MPH, ATSF, Director, CHP Pediatric Asthma Center Division of Pediatric Pulmonary Medicine at UPMC Children’s Hospital of Pittsburgh/University of Pittsburgh School of Medicine
  • Deborah Moss, MD, MPH, FAAP, Professor of Pediatrics, University of Pittsburgh Children’s Hospital of Pittsburgh of UPMC Division of General Academic Pediatrics; Pediatric Medical Director, UPMC for You; and Medical Director, UPMC for Kids
  • Erin McConnell, PharmD, Program Manager, Pharmacy Quality, UPMC Health Plan

Register now at upmchp.us/asthma. This webinar will be recorded.

You may earn continuing medical education (CME) credits for attending this webinar.*

*This activity is approved for AMA PRA Category 1 Credit™ and ANCC. Other health care professionals will receive a certificate of attendance confirming the number of contact hours commensurate with the extent of participation in this activity.

Provider is responsible for verifying CME eligibility.
7/2022COVID-19 vaccines for children
The Centers for Disease Control and Prevention (CDC) recommends COVID-19 vaccines for everyone 6 months old and older and boosters for everyone 5 years old and older, if eligible. Use CDC's COVID-19 booster tool to learn if and when a child or teen can get boosters to stay up to date with their COVID-19 vaccines.
There are two options for scheduling a child for a vaccine appointment at UPMC:
  • If a child is an existing UPMC Children's Community Pediatrics patient, they can schedule an appointment online or by calling your office.
  • If a child is NOT an existing UPMC Children's Community Pediatrics patient, patients can schedule by visiting Vaccine.UPMC.com or calling 1-844-UPMCVAC (1-844-876-2822) between 8 a.m. and 5 p.m., Monday through Friday.


Additionally, you may also visit the CDC to learn how to find a COVID-19 vaccine.

For the most recent COVID-19 policy and billing updates from UPMC Health Plan, please see these resources:

6/2022Promote the UPMC Pathways for Students Career Fair
The UPMC Pathways for Students Career Fair is an opportunity for the class of 2022 and other recent graduates to explore a range of career opportunities at UPMC. Family and friends are also encouraged to attend this career fair and celebration.

When: Wednesday, June 29, from 3 to 7 p.m.
Where: Heinz Field in the FedEx Great Hall (free parking in Gold Lot 1A)
What: Networking, resume assistance, interview guidance, meetings with hiring managers, opportunities to apply for open positions at UPMC. After networking, everyone can celebrate with food, a live DJ, and giveaways.

Interested attendees can register at upmchp.us/studentcareers..
6/2022UPMC Health Plan achieves high marks in provider satisfaction
95% of physician practice survey respondents indicate they would recommend UPMC Health Plan to other physician practices. In addition, respondents ranked UPMC Health Plan in the 93rd percentile or higher in 17 of 19 questions from the annual Provider Satisfaction Survey.

UPMC Health Plan contracts with SPH Analytics to conduct an annual Provider Satisfaction Survey. You may be invited to participate in the 2022 survey that will begin in mid-August. The survey will ask for feedback on your experience with UPMC Health Plan as well as other health plans you work with. Watch for an invitation in the mail or via email in August.
6/2022Recall: Anagrelide
Teva has recalled one lot of Anagrelide 0.5 mg capsules. Anagrelide is used to treat conditions that cause a patient’s platelet count to be too high. The drug is being recalled because testing showed that it took longer than expected for the medication to dissolve in the body. Read the full text of the Anagrelide recall.
6/2022UPMC for You is expanding across Pennsylvania in September!
We are excited to announce that the Pennsylvania Department of Human Services (PA-DHS) has awarded UPMC for You a Medicaid Managed Care Contract for all five Physical HealthChoices zones across the Commonwealth of Pennsylvania. UPMC for You currently serves the Northwest, Southwest, and Lehigh/Capital HealthChoices zones and will expand into the Northeast and Southeast zones, effective Sept. 1, 2022.*

After June 22, 2022*, your Medicaid patients will receive a letter from PA-DHS to let them know about the Medicaid Managed Care Organizations (MCOs) selected to service their HealthChoices zones. Please look for a provider toolkit arriving in the mail in the coming weeks, explaining various value-added benefits for your patients and a variety of materials to display in your office. You can also review a list of frequently asked questions at upmchp.us/ProviderFAQ.

*Go-live implementation dates and communication timelines are subject to change at discretion of the Pennsylvania Department of Human Services.
5/2022Home health telehealth update
As you know, home health services have been approved for coverage via telehealth since the onset of the COVID-19 pandemic. Based on the usage and success of home health telehealth, UPMC Health Plan has expanded the option as a permanent telehealth service when appropriate. Effective April 1, 2022, UPMC Health Plan updated the Telehealth – MP.148 policy to include home health services as a telehealth option for members as indicated in the policy. This update is a result of a collaboration between many UPMC Health Plan departments. Services covered by the policy include observation, training or education in skilled nursing, medical social work, physical therapy, occupational therapy, speech therapy, and home health aid. A telehealth visit must include audio and video components.

Home health telehealth has successfully assisted home health agencies with current staff shortages and allows members to conveniently access services in the comfort of their home in a timely and effective manner.
5/2022COVID-19 vaccine booster updates
The U.S. Food and Drug Administration authorized a second booster dose of either the Pfizer-BioNTech or the Moderna COVID-19 vaccines for adults age 50 and older and individuals age 12 and over who are moderately to severely immunocompromised.

The agency amended the emergency use authorizations as follows1:
  • A second booster dose of the Pfizer-BioNTech COVID-19 Vaccine or Moderna COVID-19 Vaccine may be administered to individuals 50 years of age and older at least four months after receipt of a first booster dose of any authorized or approved COVID-19 vaccine.
  • A second booster dose of the Pfizer-BioNTech COVID-19 Vaccine or Moderna COVID-19 Vaccine may be administered to individuals who are moderately to severely immunocompromised at least four months after receipt of a first booster dose of any authorized or approved COVID-19 vaccine. The Pfizer-BioNTech COVID-19 Vaccine may be in administered to individuals 12 years of age and older and the Moderna COVID-19 Vaccine may be administered to individuals 18 years of age and older.
  • A second booster dose of either the Pfizer-BioNTech or the Moderna COVID-19 vaccines may be administered at least four months after the first booster to individuals who have received one primary dose of the Johnson & Johnson/Janssen Vaccine with one subsequent booster of any COVID-19 vaccine.

For the most recent guidance on who can receive a booster shot, as well as specific recommendations for those who are moderately to severely immunocompromised, visit the CDC and FDA websites.

UPMC Health Plan is committed to ensuring that every eligible member has access to COVID-19 vaccines and resources to answer their questions about the COVID-19 vaccines. Health Plan members can find answers on our COVID-19 FAQ page &mdash whether they are now eligible for boosters considering their first dose.

UPMC offers online scheduling for the COVID-19 vaccines; UPMC Health Plan members can also schedule by calling a Health Care Concierge at the number on the back of their ID card.

For the most recent COVID-19 policy and billing updates from UPMC Health Plan, please see these resources:
5/2022 Recall: Accupril Tablets
Pfizer is recalling batches of Accupril tablets (Quinapril HCl – 10 mg, 20 mg, and 40 mg) due to the presence of a nitrosamine, Nnitrosoquinapril, that was observed in recent testing at levels above the Acceptable Daily Intake (ADI) level. Read the full text of the Accupril Tablets recall.
03/2022Important update: InterQual Connect Prior Authorizations
As a reminder, prior authorizations for imaging and cardio procedures previously managed by Health Help will resume formal clinical reviews effective March 1, 2022. At this time there is no change to MSK/Orthopedic reviews.

Please ensure that prior authorization requests are submitted with complete information to increase the likelihood that they will be auto approved, eliminating the need for manual review and delayed authorizations.
02/2022New requirements for physician extenders
Effective Jan. 7, 2022, Pennsylvania Department of Human Services (DHS) has changed the PROMISe ID requirements for physician extenders. CRNPs and physician assistants (PAs) are now required to register with PA DHS to render, refer, order or prescribe services for UPMC for You, UPMC Community HealthChoices, and UPMC for Kids members. Once implemented, UPMC Health Plan will follow DHS claim denial guidelines for nonregistered CRNPs and PAs. For further information or to enroll, please visit PA DHS online or call the UPMC Health Plan Provider Services team at 1-866-918-1595.
02/2022Webinar: Pediatric Behavioral Health – Best Practices for Primary Care (recorded live)
Watch the webinar recorded live Nov. 17, 2021, where Alin Severance, MD, medical director of Behavioral Health Services at UPMC Health Plan and associate medical director at Community Care Behavioral Health Organization, discusses the importance of pediatric behavioral health best practices for primary care.

During this hourlong session, Dr. Severance reviews the epidemiology of behavioral health conditions in children and adolescents, best practices for screening and treatment for the most common behavioral health disorders and when to seek referrals, and the range of referral and consultation resources available to support the care of pediatric patients.

Register or log in

You may earn continuing medical education (CME) credits for attending this webinar.*

*This activity is approved for the following credit: AMA PRA Category 1 Credit™ and ANCC. Other health care professionals will receive a certificate of attendance confirming the number of contact hours commensurate with the extent of participation in this activity.

*Provider is responsible for verifying CME eligibility.
02/2022Recall: Semglee
Mylan Pharmaceuticals Inc., a Viatris company, is recalling a batch of Semglee® (insulin glargine injection), 100 units/ml (U-100), 3mL prefilled pens, which are packaged in a labelled carton of five pens. Read the full text of the Semglee recall.
01/2022COVID-19 vaccine booster updates
There are three COVID-19 vaccines authorized or approved for use in the United States to prevent COVID-19. Pfizer-BioNTech or Moderna (COVID-19 mRNA vaccines) are preferred under CDC guidance. You may get Johnson & Johnson’s Janssen COVID-19 vaccine in some situations. The FDA has authorized boosters for Pfizer-BioNTech, Moderna and J&J vaccines and "mix and match" dosing for boosters. This means that you may receive your primary vaccine and your booster from different manufacturers.

On January 3, 2022, the U.S. Food and Drug Administration amended the emergency use authorization (EUA) for the Pfizer-BioNTech COVID-19 Vaccine to:

  • Expand the use of a single booster dose to include use in individuals 12 through 15 years of age.
  • Shorten the time between the completion of primary vaccination of the Pfizer-BioNTech COVID-19 Vaccine and a booster dose to at least five months.
  • Allow for a third primary series dose for certain immunocompromised children 5 through 11 years of age.

For the most recent guidance on who can receive a booster shot, visit the CDC or FDA.

UPMC offers online scheduling for the COVID-19 vaccines; UPMC Health Plan members can also schedule by calling a Health Care Concierge at 1-833-280-8510 (TTY: 711) Monday through Friday from 7 a.m. to 7 p.m. and Saturday and Sunday from 8 a.m. to 5 p.m.

For the most recent COVID-19 policy and billing updates from UPMC Health Plan, please see these resources:

01/2022IMPORTANT UPDATE: Extending the current UPMC Health Plan utilization model for selected MSK, cardiology, and radiology codes
Prior authorizations for procedures and imaging that were previously managed by HealthHelp (diagnostic imaging, cardiology, and MSK) will be approved until March 1st without review of clinical documentation. However, prior authorization requests must still be submitted for related claims to be paid. Please ensure that requests are submitted with complete information to increase the likelihood that they will meet criteria and be auto approved, eliminating the need for manual review and delayed authorizations.

Do not delay medically necessary care or services because you are waiting for an authorization.

Thanks in advance for your cooperation and collaboration.

Please keep in mind that an authorization is not a guarantee of payment for services rendered.
01/2022CME webinar: Behavioral Health in Primary Care: How UPMC Health Plan Can Help
Please join us for a live, CME-accredited webinar Thursday, March 10, from noon to 1 p.m.

The presentation will include an overview of behavioral health in primary care, including the following topics:
  • Background, prevalence, and best practices
  • Available supports and services at UPMC Health Plan such as the RxWell app, behavioral health condition management, and case management
  • How to prescribe these and other UPMC Health Plan supports and services with UPMC Prescription for Wellness
  • Reimbursement and potential incentives for depression screening

Presented by:
  • Alin Severance, MD, Medical Director, Behavioral Health Services at UPMC Health Plan; Associate Medical Director, Community Care Behavioral Health Organization
  • Jamie Delu, RRT, Director, Prescription for Wellness at UPMC Health Plan
  • Laura Francis, MSW, LSW, Program Director, Behavioral Integration at UPMC Health Plan
  • Rebecca Knoll, MPH, Director, Quality Provider Performance at UPMC Health Plan
  • Tanuja Tripurana, BTech in Mechanical Engineering, Senior Manager, RxWell at UPMC Health Plan

Register now at upmchp.us/bhpc. This webinar will be recorded.

You may earn continuing medical education (CME) credits for attending this webinar.*

*Provider is responsible for verifying CME eligibility. This activity is approved for the following credit: AMA PRA Category 1 Credit™, ANCC, and ASWB. Other health care professionals will receive a certificate of attendance confirming the number of contact hours commensurate with the extent of participation in this activity.
01/2022Webinar: Pediatric Dyslipidemias: Screening, Diagnosis, and Management in the Primary Care Setting (recorded live)
Watch the webinar recorded live May 19, 2021, where Brenda Mendizábal, MD, MS, Director of Pediatric Preventive Cardiology, UPMC Children’s Hospital of Pittsburgh, addresses improving the management of pediatric dyslipidemias.

During this hourlong session, Dr. Mendizábal discusses identifying children at greatest risk for accelerated atherosclerosis, formulating a plan for providing care to children with dyslipidemias, and the role of the pediatric preventive cardiologist.

Register or log in to listen to the webinar.

You may earn continuing medical education credits (CME) for watching this webinar.*

*This activity is approved for the following credit: AMA PRA Category 1 Credit™ and ANCC. Other health care professionals will receive a certificate of attendance confirming the number of contact hours commensurate with the extent of participation in this activity.

Provider is responsible for verifying CME eligibility.
01/2022Recall: Metformin ER
Viona Pharmaceuticals Inc. has recalled 33 lots of Metformin Hydrochloride Extended-Release Tablets, USP, 750 mg because an impurity found in the products is above levels established by the Food and Drug Administration. Read the full text of the Metformin ER recall.
01/2022Recall: Clobetasol
Taro Pharmaceuticals USA Inc. has recalled one lot (AC13786, Exp. 12/2022) of Clobetasol Propionate Ointment USP, 0.05% packaged in 60 g tubes. Clobetasol is a topical corticosteroid that is used to relieve inflammation and itching. Read the full text of the Clobetasol recall.
01/2022Recall: Nitroglycerin Spray
Padagis US LLC has recalled Nitroglycerin Lingual Spray because of a complaint that the product may not work correctly. Nitroglycerin Lingual Spray is used for acute (in-the-moment) relief of an attack or to prevent chest pain caused by coronary artery disease in adult patients. Read the full text of the Nitroglycerin Spray recall.
01/2022Requirements under the No Surprises Act
As of Jan. 1, 2022, Section 116 of the Federal Consolidation Appropriations Act, which addresses provider directory accuracy, became effective. It regulates the responsibility of both payers and providers regarding provider information that appears in payer provider directories. Referred to as the No Surprises Act (NSA), the Act requires the following as it applies to provider directories (paraphrased):

  • Of Payers
    • That payers verify and update the provider directory information not less frequently than once every 90 days.
    • That payers establish a process to remove providers from directories if the payer is unable to verify the providers’ information.
  • Of Providers
    • Providers shall submit provider directory information to a plan or issuers, at a minimum:
      • When providers terminate a network agreement.
      • When there are material changes to the content of provider directory information.
      • At any other time (including upon the request of such issuer or plan).

Additionally, current CMS/DHS/PID regulations are still in effect and contractual obligations to notify UPMC Health Plan of providers’ changes still apply. Incentive payment eligibility is contingent upon quarterly provider directory verification.

At the beginning of each quarter, LexisNexis will be reaching out through one or more of its three communication channels (phone, fax, or online) to verify that your provider information is accurate.

Alternatively, you can view your information by the following methods:

  1. Searching the online directory for your name at upmchealthplan.com/find. You can make updates to your information at upmchealthplan.com/providers/change.html.
  2. Searching Provider OnLine under "Reports," "Office Information Sheet." Changes can be noted on the sheet and returned to the email address below. (If this section is not available to you, you can request access via your online administrator.)

If you have any questions, have trouble with your updates, or if your contact information has changed, contact your physician account executive or email providernetworkinquiries@upmc.edu.
01/2022CME webinar: Pediatric Oral First Aid
February is National Children’s Dental Health Month, and you are invited to a timely webinar on the topic. Please join us for the live, CME-accredited webinar on Wednesday, Feb. 16, from noon to 1 p.m. Brian Martin, DMD, MHCDS, Vice President of Medical Affairs and President, Pennsylvania Pediatric Health Network (CIN), UPMC Children’s Hospital of Pittsburgh; Shannon McDonald, RDH, PHDHP, Dental Care Manager; Dana Shaffer, RDH, PHDHP, Dental Care Manager; and Doree Rossey, RDH, PHDHP, Dental Care Manager Supervisor, will discuss the different types of pediatric oral health emergencies, oral care routines to help families understand the importance of good oral health, and treatment modalities in dental offices to address various dental issues including mouthguard use. This webinar will be recorded.

Register now at upmchp.us/ohwebex.

You may earn continuing medical education credits for attending this webinar.*

*Providers are responsible for verifying CME eligibility. This activity is approved for the following credit: AMA PRA Category 1 Credit™ and ANCC. Other health care professionals will receive a certificate of attendance confirming the number of contact hours commensurate with the extent of participation in this activity.
01/2022New CME webinar on quality measures available
Providers may earn CME credits by viewing our latest webinar on the importance of implementing quality measures within the framework of clinical practice. Using this knowledge is an excellent way for a clinical practice to thrive by helping to improve efficiency, patient safety, and clinical outcomes.

Watch the Quality Measures for Primary Care Providers webinar on demand to get a “101" on quality measures. During the presentation, participants will learn:

  • The concepts of quality and value and how they apply to health care.
  • The components of a quality measure.
  • HEDIS, CAHPS, and NCQA roles in quality measures.
  • Best practices for select pediatric, behavioral, and adult measures.

Quality Reference Resources are included as part of the presentation.

Watch Quality Measures for Primary Care Providers on demand. You may earn continuing medical education credits (CME) for watching this webinar.*

*Provider is responsible for verifying CME eligibility. This activity is approved for the following credit: AMA PRA Category 1 Credit™ and AAPA Category 1 CME. Other health care professionals will receive a certificate of attendance confirming the number of contact hours commensurate with the extent of participation in this activity.
01/2022CME webinar: Addiction Care for the Non-Addiction Provider Part 4 – Overview of Management and Available Resources
Please join us for a live, CME-accredited webinar Wednesday, March 23, from noon to 1 p.m. Michael Lynch, MD, Medical Director, Pittsburgh Poison Center; Medical Director, UPMC Health Plan Substance Use Disorder Services; and Assistant Professor of Emergency Medicine, Toxicology, Pediatrics, and Addiction at the University of Pittsburgh, will summarize the continuum of care for a patient with a substance use disorder (SUD) in an outpatient setting, including available resources to assist non-addiction providers with meeting the needs of these patients. This will be part 4 of a 4-part series.

During the program, Dr. Lynch will:

  • Present data regarding the prevalence and impact of SUDs on society and health care.
  • Provide an overview of feasible screening, brief intervention, and referral to treatment processes, including reimbursement opportunities.
  • Review basic medical management principles for patients with SUDs.
  • Describe existing support and referral resources available to Pennsylvania providers to connect patients to ongoing care.

Register today at upmchp.us/ac4. This webinar will be recorded.

You may earn continuing medical education credits for attending this event.*

*Provider is responsible for verifying CME eligibility. This activity is approved for the following credit: AMA PRA Category 1 Credit™, ANCC, and ASWB. Other health care professionals will receive a certificate of attendance confirming the number of contact hours commensurate with the extent of participation in this activity.
01/2022COVID-19 vaccines – No cost share for members
UPMC Health Plan believes that vaccination is important, helps protect our communities, and saves lives. We advocate that all who can be vaccinated should be vaccinated. Since the first Emergency Use Authorizations were granted, the COVID-19 vaccine has been covered as a preventive service at no cost for UPMC Health Plan members. This applies to all of our comprehensive medical coverage products, including UPMC for Life, UPMC for Life Complete Care, UPMC for You, UPMC for Kids, UPMC Community HealthChoices, and all UPMC commercial group and individual (Pennie/Marketplace) products.

CMS has provided billing guidance and vaccine toolkits that can be found at cms.gov/COVIDvax. As of Jan. 1, 2022, vaccination claims for members with UPMC for Life (Medicare Advantage) should go to UPMC Health Plan, not Medicare Fee-For-Service. To learn more, visit our provider FAQ and Appendix A for more information.
01/2022UPMC Health Plan recommends COVID-19 booster shots for all who are eligible
The CDC recently indicated that everyone ages 16 and older can get a COVID-19 booster shot.

  • 16-17-year-olds can only get a Pfizer vaccine booster.
  • Those 18 and older can get a booster with any of the COVID-19 vaccines.

Pfizer and Moderna boosters should be given at least six months after the second vaccine. The Johnson & Johnson booster should be given at least two months after the first vaccine.

To read more about booster shots, visit the CDC's webpage.

For the most recent COVID-19 policy and billing updates from UPMC Health Plan, please see these resources:

2021 Announcements

12/2021Updated blood lead reference value for children
The Centers for Disease Control and Prevention (CDC) recently updated its blood lead reference value (BLRV) from 5 µg/dL to 3.5 µg/dL in response to a recommendation by the Lead Exposure Prevention and Advisory Committee (LEPAC).

The BLRV aims to identify children with higher levels of lead in their blood compared to most children, based on the 97.5th percentile of the blood lead level (BLL) distribution in U.S. children ages 1 to 5 years.1 However, the CDC states that there is no safe BLL in children and that even low levels of lead in blood can affect learning and academic achievement and have permanent effects. It is critical for providers to partner with parents and caregivers to help prevent exposure and lower a child’s lead level, if necessary. To connect members with case management and for environmental lead investigation support, please contact the UPMC Pediatric Care Management Department. You can email a referral to pedscasemanagement@upmc.edu or call 1-866-778-6073 and select “pediatrics.”

Learn more
For more information about BLL in children, visit cdc.gov/nceh/lead/prevention/blood-lead-levels.htm. You can also view the UPMC Health Plan Lead Screening Provider Tip Sheet.

Source
1Centers for Disease Control and Prevention. CDC updates blood lead reference value for children. Last reviewed Oct. 28, 2021. Accessed Nov. 2, 2021. cdc.gov/media/releases/2021/p1028-blood-lead.html
12/2021Reminder: Updates to policies MP.PA.131-138
Per November’s issue of Provider Partner Update, UPMC Health Plan will implement the new policies listed below effective Jan. 1, 2022.

  • MP.PA.131 Cardiac Defibrillator, Wearable
  • MP.PA.132 Vertebral Augmentation
  • MP.PA.133 Knee Arthroplasty
  • MP.PA.134 Spinal Fusion
  • MP.PA.135 Lumbar Spinal Decompression
  • MP.PA.136 Shoulder Procedures
  • MP.PA.137 Cardiac Devices, Implantable Defibrillator and Pacemaker
  • MP.PA.138 Hip Arthroplasty

As a reminder, authorization is required for all members regardless of age and for all lines of business.

It is the policy of UPMC Insurance Services Division to cover services when medically necessary and covered by the member’s benefit plan for the specific indications detailed in the policies.

For the complete list of indications and limitations, refer to the above-referenced policies in the UPMC Health Plan policies and procedures manual.

If you have any questions regarding this update, please contact your network manager, provider account executive or call Provider Services at 1-866-918-1595.
12/2021Lab Benefit Manager update
Lab Benefit Manager implementation has been moved from Jan. 1, 2022, to Feb. 1, 2022. This will give our valued providers additional preparation time. Please contact your physician account executive with any questions.
12/2021New Extended Network collaboration provides access to Cigna PPO Network1 providers while outside UPMC Health Plan service area
Members enrolled in our commercial plans have full access to all UPMC-owned providers, many community-based doctors and hospitals, and a national Extended Network outside of the UPMC Health Plan service area. As of Jan. 1, 2022, this national network will move from PHCS/MultiPlan to the Cigna PPO Network for members outside the UPMC Health Plan service area and Ohio.2,3 Provider contracts outside the service area affected by this change will be contacted by the UPMC Health Plan Network Development team. UPMC for Kids travel network will remain with PHCS/MultiPlan. If any member is seeking care in Ohio, they will continue to access care through the SuperMed Preferred Provider Organization Network. To determine if a provider is in the extended network, you can use our online directory at upmchealthplan.com/find. All members will receive new ID cards.

Learn more about this coverage and other important updates in this month’s Provider Partner Update. If you have any questions, please reach out to your physician account executive or call Provider Services at 1-866-918-1595.

1The Cigna PPO Network refers to the health care providers (doctors, hospitals, specialists) contracted as part of the Cigna PPO Network for Shared Administration.

2Cigna is an independent company and is not affiliated with UPMC Health Plan Inc. and its affiliates. Access to the Cigna PPO Network is available through Cigna's contractual relationship with UPMC Health Plan Inc. All Cigna products are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property Inc. 3UPMC Health Plan members residing in Bucks, Chester, Delaware, Franklin, Fulton, Juniata, Mifflin, Montgomery, Montour, and Philadelphia counties in Pennsylvania; all other states except Ohio; Garrett and Allegany counties in Maryland; and Chautauqua, Cattaraugus, and Allegany counties in New York can access the Cigna PPO Network as their primary network. UPMC Health Plan commercial members and their dependents who reside in Ohio or while traveling in the state will continue to access care through the SuperMed PPO Network and, while traveling outside of the state of Ohio, can also utilize the Cigna PPO Network.
12/2021Webinar: Food Security Screening & Intervention in Pediatric Populations (live and recorded)
Watch the live recorded online webinar held on Aug. 18, 2021, where Dr. Jodi Krall, PhD, project director, UPMC Children’s Hospital of Pittsburgh, Community Health Division, and Sarah Elizabeth Morrow, program manager for Collaborative Health at UPMC Health Plan, discuss the importance of food security screenings for pediatric populations. During this hour-long session, they discussed the relationship between food insecurity and children’s health, current approaches for addressing food insecurity in pediatrics, and how to identify and advise on food insecurity.

Register or log in to listen to the webinar.

You may earn continuing medical education credits for watching this webinar.*

*This activity is approved for the following credit: AMA PRA Category 1 Credit™, ANCC. Other health care professionals will receive a certificate of attendance confirming the number of contact hours commensurate with the extent of participation in this activity.

Provider is responsible for verifying CME eligibility.
12/2021DHS reinstated PROMISe ID revalidation requirements for Medical Assistance providers
Provider revalidation requirements resumed in June 2021. They apply to providers who provide, order, refer, or prescribe services for Medical Assistance, Community HealthChoices, or CHIP members. These providers must enroll every service location where they see members with the Department of Human Services (DHS) and obtain a PROMISe™ ID (also known as Medicaid ID or MPI). Revalidation of these locations is required every five years.

All service locations must comply to avoid claim denials.

Because of the COVID-19 public health emergency (PHE), a section 1135 waiver allowed DHS to apply certain temporary flexibilities related to provider enrollment and revalidation requirements.

As of June 1, 2021, DHS reinstated provider revalidation requirements as applicable prior to the COVID-19 PHE.

Take action: Submit revalidation applications.

Providers will receive notification from DHS 90 days and 30 days in advance of their enrollment expiration date. PROMISe ID revalidation applications must be submitted by the due dates indicated in 90-day and 30-day notices for revalidations due on and after June 1, 2021.

If you are past the revalidation date, you need to take immediate action to correct this. Failure to do so will result in denial of claims for service locations that have not be revalidated or do not have an active PROMISe ID. Claim denials
All claims for rendering, ordering, referring, or prescribing providers without an active PROMISe ID will be denied for UPMC for You (Medicaid), UPMC for Kids (CHIP), and UPMC Community HealthChoices patients.

Know where to go
Providers should log in to PROMISe to check the revalidation dates of each service location and submit revalidation applications at least 60 days prior to the revalidation dates. Providers should also enroll for any locations that are not listed in PROMISe. Enrollment (revalidation) applications are located on the DHS website.

Learn more
Providers can read Medical Assistance Bulletin 99-21-01 to learn more about the restoration of provider revalidation requirements.

Questions?
Please contact DHS with questions about the following:
  • Provider enrollment
  • Revalidation
  • Enrollment fees
  • Site visits
  • Criminal background checks

You can reach DHS regarding these matters at 1-800-537-8862 (option 2, option 4, option 2).
12/2021CME webinar: E&M Documentation for Diagnosis Reporting (recorded)
Watch UPMC Health Plan Program Director Marlana Tice and Lead Physician Educator Brenda Stevenson discuss improving E&M documentation for diagnosis reporting. The hour-long session covers these topics:
  • Provider documentation requirements and guidelines for E&M and ICD-10-CM diagnosis reporting
  • The connection between the new 2021 E&M documentation guidelines and ICD-10-CM reporting
  • The importance of reporting diagnoses for severity of illness
  • Risk adjustment overviews and risk adjustment data validation (RADV) audits
  • Diagnoses that are problematic to RADV audits in terms of provider documentation and ICD-10-CM code assignment

You may earn continuing medical education credits* for watching this recorded webinar.

Watch the E&M Documentation for Diagnosis Reporting webinar.

*Provider is responsible for verifying CME eligibility. This activity is approved for the following credit: AMA PRA Category 1 Credit™, ANCC. Other health care professionals will receive a certificate of attendance confirming the number of contact hours commensurate with the extent of participation in this activity.
12/2021Recall: Enoxaparin (Sandoz – Dec.)
Sandoz Inc. is recalling one lot (SAB06761A, Exp. 04/2023) due to a portion of the lot being exposed to a higher temperature, which may affect the effectiveness of the drug. Enoxaparin Sodium injection is a blood thinner that is used to prevent and treat blood clots and heart attacks. Read the full text of the Enoxaparin (Sandoz – Dec.) recall.
12/2021New telehealth POS code starting Jan. 1, 2022
CMS released guidelines for a new Place of Service (POS) Code for telehealth as well as a new definition for POS 02.

POS 02: Telehealth Provided Other than in Patient’s Home Descriptor: The patient location when health services and health related services are provided or received, through telecommunication technology. POS 02 should be used when the patient is not located in their home when receiving health services or health related services through telecommunication technology.

POS 10: Telehealth Provided in Patient’s Home Descriptor: The patient location when health services and health related services are provided or received through telecommunication technology. POS 10 should be used when the patient is located in their home (which is a location other than a hospital or other facility where the patient receives care in a private residence) when receiving health services or health related services through telecommunication technology.

As of Jan. 1, 2022, UPMC Health Plan will recognize and accept POS 10 the updated definition for POS 02 for all lines of business. There is no change to reimbursement associated with the POS codes.

The UPMC Health Plan Telehealth Policy MP.148 will reflect this effective Jan. 1, 2022.

The provider of care is ultimately responsible for providing accurate and compliant information on all submission of claims and/or billing information.
12/2021Added clarity re. DHS guidance on telehealth services for FQHCs and RHCs providers
Services rendered through telehealth at Federally Qualified Health Centers, Federally Qualified Health Centers Look-Alike Centers, or Rural Health Clinics by UPMC for You, UPMC for Kids¸ and UPMC Community HealthChoices Medical Assistance participating providers will be paid at the same rate as if they were rendered in person, using standard office visit codes (e.g., HCPCS code T1015) with place of service 02.

The telehealth service must be rendered in conformance with the full description of the procedure code, in a clinically appropriate manner, and to the extent that it would have been rendered if the visit had occurred in person. No additional payment will be made for the technology used to render telehealth services. Consistent with Pennsylvania DHS guidance (Bulletin 99-21-06) that applies to all HealthChoices Medical Assistance Providers, UPMC Health Plan will allow for the use of telephone-only services where video technology is not available.
12/2021Skilled nursing facility prior authorizations
Effective Dec. 16, 2021, UPMC Health Plan will waive the initial prior authorization requirements for members who are being transferred from an inpatient setting to a skilled nursing facility (SNF). Inpatient providers are still required to notify UPMC Health Plan of the planned SNF transfer, but the initial placement request will not be reviewed for prior authorization based on medical necessity.

UPMC Health Plan will coordinate with the receiving SNF to perform a medical necessity review for ongoing placement following the initial authorization, consistent with UPMC Health Plan’s standard policy for placements. SNFs must still adhere to UPMC Health Plan’s authorization policies, including those regarding the review of continuing/ongoing placements. Out of network authorizations for skilled nursing facilities may be authorized due to capacity and placement requirements. However, out-of-network authorization is not automatic and UPMC Health Plan must be notified of any request for out of network transfers. UPMC Health Plan staff will work with the requesting provider to locate an available in-network facility or make arrangements with an out-of-network facility as necessary.
12/2021CME presentation: Healthcare Inequalities and Addressing Disparities (recorded)
Listen to Dr. Nicholas DeGregorio and Dr. Johanna Vidal-Phelan discuss the nature and root causes of health care inequities and the key pillars for addressing disparities. They will also examine the relationships among health disparities, social determinants of health, and health outcomes and review UPMC Health Plan initiatives to provide suggestions to reduce health care disparities and improve health equity.

Review the presentation

You may earn continuing medical education credits for watching this webinar.*

*Provider is responsible for verifying CME eligibility. This activity is approved for the following credit: AMA PRA Category 1 Credit™, ANCC. Other health care professionals will receive a certificate of attendance confirming the number of contact hours commensurate with the extent of participation in this activity.
12/2021Mandatory training for Medicare SNP providers
The Centers for Medicare and Medicaid Services (CMS) require all Medicare Special Needs Plan (SNP) providers to complete the Model of Care Training. The Model of Care describes the structure and process by which health care services are delivered to SNP members.

You must complete this training by March 1, 2022.

For your convenience, UPMC Health Plan has developed a brief online training module on the Model of Care for our SNP product, UPMC for Life Complete Care (HMO-SNP).

To complete the training, go to upmchp.us/snpmoctraining. You will need your tax identification number to sign up.

The training is also available on Provider OnLine. You can find it under Provider Training in the Documents and Forms section.

If you have any questions or concerns, feel free to contact your physician account executive or call Provider Services at 1-866-918-1595.

Thank you for your continued support and the care you provide for our members!
12/2021Q1 provider directory updates required
As you know, UPMC Health Plan requires all providers to verify their provider directory information at least every 90 days (quarterly). This allows us to comply with CMS/DHS/PID requirements to maintain accurate directories—as well as the federal No Surprises Act (effective Jan. 1, 2022). Accurate directories are the primary way our members find in-network care.

UPMC Health Plan quality programs also require provider directory verification as a condition of participation and payment. In addition, failure to attest every 90 days may result in further action per your participating provider agreement.

Ways to keep your information current
At the beginning of each quarter, LexisNexis will be reaching out through one or more of its three communication channels (phone, fax, or online) to verify that your provider information is accurate.

You can visit the provider directory to ensure that your provider information and office details are up to date and accurate. Here is the information that must be reviewed/updated/verified:
  • Ability to accept new patients
  • Street address
  • Phone number
  • Office hours
  • Products accepted
  • Hospital privileges
  • Whether your practice offers telehealth services (optional but encouraged)
  • Any other information that affects your availability to our members

You can view your information by searching the online directory for your name at upmchealthplan.com/find. You can make updates to your information at upmchealthplan.com/providers/change.html.

If you have any questions, need help with your updates, or need to change your contact information, please contact your physician account executive or email providernetworkinquiries@upmc.edu.

Thank you for your support in this ongoing effort!

LexisNexis cannot change your product participation or the services contracted by your practice. If you have questions or concerns regarding product participation or contracted services, contact your physician account executive.
12/2021Stay up to date on the Philips Respironics recall
In June 2021, Philips Respironics issued a global, voluntary recall for some of its sleep and respiratory care products. The recall aims to address identified potential health risks related to the polyester-based polyurethane (PE-PUR) sound abatement foam in these devices.

Philips is facilitating the replacement of repaired equipment, as it becomes available, for users who register affected devices with the company. Alternative temporary/loaner equipment is currently limited for durable medical equipment (DME) providers due to increased demand.

Philips updates durable medical equipment (DME) providers on various aspects of the current remediation status. DME providers and other providers can visit the Philips' recall website for current information on the recall. UPMC Health Plan members can contact us at 1-844-220-4785 if they have additional questions.
11/2021Children ages 5 to 11 are now eligible to receive the COVID-19 vaccine
Children 5 years old and older can now receive the Pfizer-BioNTech COVID-19 Vaccine. Children 5 through 11 years old will receive a separate vaccine formulation, denoted with an orange cap, of the Pfizer-BioNTech COVID-19 Vaccine that has one-third the dose given to adolescents and adults, and will receive the vaccine with a smaller needle. An overview of the description of the differences in the adult/adolescent formulation and pediatric formulation is available on the CDC website.

UPMC offers online scheduling for the COVID-19 vaccines; UPMC Health Plan members can also schedule by calling a Health Care Concierge at 1-833-280-8510 (TTY: 711) Monday through Friday from 7 a.m. to 7 p.m. and Saturday and Sunday from 8 a.m. to 5 p.m.

For the most recent COVID-19 policy and billing updates from UPMC Health Plan, please see these resources:

Children between the ages of 2 and 4 years old, other unvaccinated children 5 years or older and adults should continue to wear a mask in public spaces and around people they don’t live with.1

As a trusted resource of factual information about the safety and effectiveness of the vaccine, health care providers are critical to helping combat myths and fears. Visit the CDC website to learn more about how to answer parents’ and caregivers’ questions about the COVID-19 vaccines.

Source
1Centers for Disease Control and Prevention. COVID-19 Vaccine FAQs for Healthcare Professionals. Last reviewed: Nov. 8, 2021. Nov. 8, 2021. cdc.gov/vaccines/covid-19/planning/children.html#clinical-training-education
11/2021CME webinar: Addiction Care for the Non-Addiction Provider, Part 3 – Opioid Use Disorder Management
Please join us for a live, CME-accredited webinar on Feb. 23 from noon to 1 p.m. Michael Lynch, MD, Medical Director, Pittsburgh Poison Center; Medical Director, UPMC Health Plan Substance Use Disorder Services; and Assistant Professor of Emergency Medicine, Toxicology, Pediatrics, and Addiction at the University of Pittsburgh, will discuss opioid use disorder management for the non-addiction provider. This will be part 3 of a 4-part series.

During the program, Dr. Lynch will:

  • Present national and PA-specific opioid overdose death trends.
  • Describe basis for recommending medication treatment for opioid use disorder (MOUD).
  • Discuss different MOUD options.
  • Review buprenorphine induction and maintenance therapy including special populations and drug screens.
  • Summarize CDC naloxone prescribing recommendations.
  • Name several available resources for assistance with patient care and referral.

Register today at upmchp.us/ac3. This webinar will be recorded.

You can plan ahead and register for Addiction Care for the Non-Addiction Provider, Part 4:
Dates Times Registration
March 23 Noon to 1 p.m. upmchp.us/ac4

You may earn continuing medical education credits for attending this event.*

*Provider is responsible for verifying CME eligibility. This activity is approved for the following credit: AMA PRA Category 1 Credit™ and ANCC. Other health care professionals will receive a certificate of attendance confirming the number of contact hours commensurate with the extent of participation in this activity.
11/2021Available now: New CGMA capability
Effective Monday, Nov. 29, a new CGMA capability allows users to upload medical record documentation to close the BMI percentile gap for the Weight Assessment for Children/Adolescents (WCC) measure. Users will now see "Upload" under the action column on the member gaps page for this measure and will be able to submit documentation for review.
11/2021Recall: Irbesartan Tablets
Lupin Pharmaceuticals Inc. is recalling batches of Irbesartan Tablets, USP and Irbesartan and Hydrochlorothiazide Tablets, USP due to the presence of an impurity that may cause cancer. This is a medicine that treats high blood pressure as well as nephropathy (kidney disease) caused by type 2 diabetes. Read the full text of the Irbesartan recall.
11/2021CME webinar: Addiction Care for the Non-Addiction Provider, Part 2 – Alcohol Use Disorder Management
Please join us for a live, CME-accredited webinar on Jan. 19 from noon to 1 p.m. Michael Lynch, MD, Medical Director, Pittsburgh Poison Center; Medical Director, UPMC Health Plan Substance Use Disorder Services; and Assistant Professor of Emergency Medicine, Toxicology, Pediatrics, and Addiction at the University of Pittsburgh, will discuss alcohol use disorder management for the non-addiction provider. This will be part 2 of a 4-part series.

During the program, Dr. Lynch will:

  • Present the prevalence and impact of alcohol use disorder (AUD) and withdrawal.
  • Describe AUD screening and withdrawal assessment.
  • Review medical management of alcohol withdrawal and AUD.
  • Explore non-medication interventions for patients with AUD.
Register today at upmchp.us/ac2. This webinar will be recorded.

You can plan ahead and register for Addiction Care for the Non-Addiction Provider, Parts 3 and 4:
Dates Times Registration
Feb. 23 Noon to 1 p.m. upmchp.us/ac3
March 23 Noon to 1 p.m. upmchp.us/ac4
You may earn continuing medical education credits for attending this event.*

*Provider is responsible for verifying CME eligibility. This activity is approved for the following credit: AMA PRA Category 1 Credit™ and ANCC. Other health care professionals will receive a certificate of attendance confirming the number of contact hours commensurate with the extent of participation in this activity.
11/2021CME webinar: Addiction Care for the Non-Addiction Provider, Part 1 – Screening and Initial Intervention
Please join us for a live, CME-accredited webinar on Dec. 8 from noon to 1 p.m. Michael Lynch, MD, Medical Director, Pittsburgh Poison Center; Medical Director, UPMC Health Plan Substance Use Disorder Services; and Assistant Professor of Emergency Medicine, Toxicology, Pediatrics, and Addiction at the University of Pittsburgh will discuss screening and initial intervention for the non-addiction provider. This will be part 1 of a 4-part series.

During the program, Dr. Lynch will:

  • Describe the current effects of substance use disorders on morbidity and mortality.
  • Discuss the physiology of addiction.
  • Review prevalence data and stigma/language associated with SUD and its care.
  • Present available screening tools and processes.
  • Describe practices that reduce harm and morbidity associated with substance use.
  • Discuss implementation barriers and opportunities.
Register today at upmchp.us/ac1.

You may earn continuing medical education credits for attending this event.*

*Provider is responsible for verifying CME eligibility. This activity is approved for the following credit: AMA PRA Category 1 Credit™ and ANCC. Other health care professionals will receive a certificate of attendance confirming the number of contact hours commensurate with the extent of participation in this activity.
11/2021Pharyngitis testing now available at Quest Diagnostics
You can send your patients of all ages who are UPMC Health Plan members to any Quest Diagnostics Patient Service Center (PSC) in Pennsylvania for pharyngitis tests, including the following:

Learn more

11/2021U.S. Antibiotic Awareness Week Nov. 18–24
Join the Centers for Disease Control and Prevention (CDC) in observing U.S. Antibiotic Awareness Week (USAAW) Nov. 18–24. This annual observance raises awareness of the threat of antibiotic resistance and the importance of appropriate antibiotic use.

Learn about other ways you can participate in USAAW to improve antibiotic prescribing and protect your patients.

Review the Be Antibiotics Aware Partner Toolkit.
11/2021Recall: Losartan Potassium Tablets, USP
Jubilant Cadista Pharmaceuticals Inc. is withdrawing all quantities of unexpired lots of Losartan Potassium Tablets, USP; and Losartan Potassium and Hydrochlorothiazide Tablets, USP due to the presence of an impurity that may increase the risk of cancer. Read the full text of the Losartan Potassium Tablets, USP recall.
11/2021Recall: Lidocaine (Teligent)
Teligent is recalling a few lots of Lidocaine Hydrochloride Topical Solution 4% (40 mg/mL), due to the lot being super potent (higher than normal or acceptable potency). Read the full text of the Lidocaine (Teligent) recall.
11/2021FDA, CDC greenlight Moderna and J&J boosters, allow “mix and match”
Federal guidance and authorization now include boosters for Moderna and Johnson & Johnson/Janssen (J&J) vaccines, joining previous authorization of Pfizer boosters, as well as the ability to "mix and match" doses from different manufacturers.

The CDC says all three COVID-19 vaccines continue to work well at reducing the risk of severe disease, hospitalization, and death. A booster dose of vaccine is not unusual and is a common way to ensure the immune system remains prepared; children and adults regularly receive boosters of common vaccinations like Tdap (tetanus, diphtheria, and pertussis) or MMR (measles-mumps-rubella).

Who is now eligible for boosters?
While all three available vaccines have been authorized as booster doses, eligibility and timing varies based on the brand of vaccine you originally received.

You received the J&J vaccine initially:
You are eligible for a booster if you received your first dose of at least two (2) months ago AND:
  • You are 18 years of age or older
You received the Pfizer or Moderna vaccine initially:
You are eligible for a booster if you received your second dose at least six (6) months ago AND:
  • You are 65 years of age or older
  • OR you are 18 years of age or older and residing in a long-term care setting
  • OR you are 18 years of age or older and have a high-risk underlying medical condition
  • OR you are 18 years of age or older and are at increased risk for COVID-19 exposure and transmission because of occupational or institutional setting
If you are eligible for a booster based on the above, you may select ANY of the three vaccine brands for your booster.

Under this new guidance, health care workers are eligible for any of the three vaccine boosters.

What about “mix and match” dosing for boosters?
The FDA on Wednesday, Oct. 20, authorized boosters for Moderna and J&J vaccines and "mix and match" dosing for boosters. This means that you may receive your primary vaccine and your booster from different manufacturers. That authorization was followed on Thursday, Oct. 21, by a unanimous recommendation from the ACIP, the CDC's advisory committee on immunization practices, and endorsement by the director of the CDC. While the authorized dosage and formulation for any booster will be the same no matter which primary vaccine you received, the timing of your booster may change based on whether you received Pfizer/Moderna or the J&J primary vaccine.

For the most recent COVID-19 policy and billing updates from UPMC Health Plan, please see these resources:

10/2021COVID-19 vaccine updates
Pfizer-BioNTech COVID-19 Vaccine Booster Shot
On Sept. 22, 2021, the U.S. Food and Drug Administration (FDA) amended the emergency use authorization for the Pfizer-BioNTech COVID-19 Vaccine to allow for use of a single booster dose, to be administered at least six months after completion of the primary series. The CDC recommends COVID-19 Vaccine booster shots for the following Pfizer-BioNTech vaccine recipients who completed their initial series at least six months ago:

  • People 65 years and older and residents in long-term care settings should receive a booster shot of Pfizer-BioNTech’s COVID-19 vaccine at least 6 months after their Pfizer-BioNTech primary series,
  • People aged 50–64 years with underlying medical conditions should receive a booster shot of Pfizer-BioNTech’s COVID-19 vaccine at least 6 months after their Pfizer-BioNTech primary series,
  • People aged 18–49 years with underlying medical conditions may receive a booster shot of Pfizer-BioNTech’s COVID-19 vaccine at least 6 months after their Pfizer-BioNTech primary series, based on their individual benefits and risks, and
  • People aged 18-64 years who are at increased risk for COVID-19 exposure and transmission because of occupational or institutional setting may receive a booster shot of Pfizer-BioNTech’s COVID-19 vaccine at least 6 months after their Pfizer-BioNTech primary series, based on their individual benefits and risks.
Third Dose of Moderna and Pfizer-BioNTech for Immunocompromised
The FDA had previously authorized an additional vaccine dose of Pfizer or Moderna for people with weakened immune systems. Immunocompromised patients are eligible to receive a third dose of the Moderna or Pfizer vaccines at least 28 days after the second dose. UPMC offers online scheduling for the COVID-19 vaccines; UPMC Health Plan members can also schedule by calling a Health Care Concierge at 1-833-280-8510 (TTY: 711) Monday through Friday from 7 a.m. to 7 p.m. and Saturday and Sunday from 8 a.m. to 5 p.m.

For the most recent COVID-19 policy and billing updates from UPMC Health Plan, please see these resources:

10/2021Advancing health equity through community-based solutions
You are invited to join an advocacy session on Tuesday, Nov. 16, 2021, from noon to 5 p.m. through the 2021 Magee-Womens Summit. This session will highlight the critical importance of tackling tough issues with communities who are facing adversity.

You are also invited to attend the full three-day CME-accredited conference, which will cover an advocacy session on Nov. 16 and move to two full days of research and clinically focused keynote talks and panel discussions on Nov. 17 and 18.

Learn more about the conference and to register at mageesummit.org/conference.

The conference will be held in-person as well as virtually. Please register by Nov. 4, 2021.
10/2021Pediatric telehealth quality measures
As we wind down 2021, UPMC Health Plan would like to remind providers of several quality measures that may be closed via telehealth.

For pediatricians, there are four:

  • Child and Adolescent Well-Care Visits (WCV), 30 months and over
  • Nutrition Counseling (WCC)
  • Physical Activity Counseling (WCC)
  • BMI (WCC)
Nutrition Counseling, Physical Activity, and BMI can be conducted outside of a WCV during any other visit type via telehealth, such as a sick visit.
10/2021Recall: Glucagon Emergency Kit
Eli Lilly and Company is recalling the Glucagon Emergency Kit lot D239382D, expiration April 2022, due to a product complaint that the vial of Glucagon is in a liquid form instead of a powder form. Read the full text of the Glucagon Emergency Kit recall.
10/2021CME webinar: Pediatric Behavioral Health – Best Practices for Primary Care
Please join us for a live, CME-accredited webinar on Nov. 17 from noon to 1 p.m. Dr. Alin Severance, Medical Director of Behavioral Health Services at UPMC Health Plan and Associate Medical Director at Community Care Behavioral Health Organization, will discuss ways to implement pediatric behavioral health best practices for primary care.

Register now at upmchp.us/bhwebex.

Find additional details on the event flier and share with interested colleagues.

*Providers are responsible for verifying CME eligibility. This activity is approved for the following credit: AMA PRA Category 1 Credit™ and ANCC. Other health care professionals will receive a certificate of attendance confirming the number of contact hours commensurate with the extent of participation in this activity.
10/2021Resolve claim denials without filing an appeal
You can quickly address questions on claim reconsiderations—often in the same day—in two easy ways:
  • Call Provider Services at 1-866-918-1595.
  • Send your question through Provider OnLine.

Using either of these avenues instead of filing an official appeal eliminates the up to 60-day response time and saves the resources and costs associated with an appeal.

If you feel a claim was denied in error (other than for medical necessity), please contact Provider Services and let us try to help you resolve your issue.
10/2021Philadelphia providers can enroll their sites for COVID-19 vaccine distribution
The Philadelphia Immunization Program is working with the Centers for Disease Control (CDC) to ensure COVID-19 vaccine is accessible to anyone in the city of Philadelphia who wishes to be vaccinated.

Providers can download the COVID-19 Enrollment Guide for step-by-step directions on how to enroll their site for COVID-19 vaccine distribution. To learn more, visit the program's COVID-19 website or email vaccines@phila.gov.
10/2021New PT authorization policy webinars
Attend one of our webinars to prepare for the implementation of the new authorization policy, Physical Therapy Services – MP.PA.129, effective Nov. 1, 2021. Any staff members who are involved in authorization requests should attend. Dates are available in October and November. Register and view additional information at upmchp.us/ptauthorizationpolicy.
10/2021UPMC Total Care – IBD support services offers access to behavioral health and nutrition services
UPMC Total Care–IBD clinical program is a comprehensive IBD program for UPMC Health Plan members that has proven results decreasing the use of inpatient and emergency department services for IBD patients. To learn more about this program and how clinicians can use it to help UPMC Health Plan members, read the article in October's Provider Partner Update.
10/2021Reinstatement of UPMC for Kids copayments for non-COVID-19 related services
Effective Oct. 1, 2021, copayments are being reinstated for all non-COVID-19 related services for UPMC for Kids members. We will continue to waive copayments for members for in-network COVID-19 diagnosis and treatment; however, low-cost and full-cost UPMC for Kids CHIP members will have copayments for non-COVID-19 related services such as sick visits to the PCP, specialist visits, urgent care, and emergency care.
10/2021Novillus measure: Childhood Immunization Status
We are excited to announce the launch of the Childhood Immunization Status (CIS) measure. This measure was initially deployed as display-only, but is now actionable. UPMC Health Plan has been working diligently in conjunction with Novillus to provide an enhanced user experience that will allow multiple uploads at different times, or submission of a group of vaccinations at one time. It will also present claims history, which will allow users to see current vaccinations that are already compliant or noncompliant. The new display will show two statuses, the first regarding compliance with the NCQA measure guidelines. This will be displayed under “CGMA Submission Status” as approved or rejected once reviewed by the Health Plan Nurse Review team. The second status will be under “14-day Complaint,” which refers to the NCQA 14-day rule. This will display as a green check or red X after processing through our HEDIS rules engine. We appreciate your patience as we work to provide the best user experience for this measure. For more information, select the Frequently Asked Questions menu item in the CGMA by clicking on the question mark icon in the upper right corner.

If you have questions about the Novillus CGMA, email UPMCCGMASupport@upmc.edu.
9/2021CDC warns against off-label use for COVID-19 vaccines
The Centers for Disease Control and Prevention (CDC) guidelines are clear: Off-label use, including through booster shots or administration to patients outside of currently authorized age group(s), is NOT currently authorized for COVID-19 vaccines.1

Administration of the off-label product may not be covered under the PREP Act or the PREP Act declaration, and such use could come with consequences for providers and patients:

  • Providers may not have immunity from claims.
  • Individuals who receive a third dose may not be eligible for compensation after a possible adverse event.

Off-label use is in violation of the CDC COVID-19 Vaccination Program provider agreement, therefore it:

  • May not be reimbursable (administration fees for off-label doses may not be reimbursed by payers).
  • May impact a provider’s ability to remain in the CDC Program.
  • Could put a provider at risk of other potential sanctions.

To learn more, visit the CDC's COVID-19 Vaccine FAQ for health care professionals.

Source
1Centers for Disease Control and Prevention. COVID-19 Vaccine FAQs for Healthcare Professionals. Last reviewed: August 26, 2021. Accessed Sept. 8, 2021. https://www.cdc.gov/vaccines/covid-19/hcp/faq.html#off-label-use
9/2021Lab Benefit Manager update
Based on provider feedback regarding implementation of the Lab Benefit Manager (LBM), UPMC Health Plan is moving the implementation date for the Lab Benefit Manager to Jan. 1, 2022, from the previous date of Oct. 1, 2021. The effective date of the LBM policies and procedures (MP.A001 through MP.A074) will be changed to 1/1/22; they will remain available for providers to view on the UPMC Health Plan Policies and Procedures webpage. All current UPMC Health Plan Policies and Procedures applicable to laboratory services will remain in effect through Dec. 31, 2021. The LBM webinar schedule will be updated to provide additional webinars closer to the implementation date. In addition, provider account executives will continue to outreach to providers for education. The LBM Claims Advice Tool will remain active on Provider OnLine to give providers the ability to review claims that will be subject to the LBM policies and procedures effective 1/1/22. The change in implementation date will allow additional time for provider education, addressing provider questions, and allowing providers to familiarize themselves with the LBM policies and LBM Claims Advice Tool in preparation for the 1/1/22 implementation date.
9/2021New CGMS capability for Childhood Immunization Status measure
Starting Monday, Oct. 4, a new CGMA capability will be available. Users will be able to upload medical record documentation to close the Childhood Immunization Status (CIS) measure. Once this feature is available, users will see a new status in the CGMA called “Manage.” Clicking on Manage will take users to a new page where claims and CGMA submissions can be viewed, and new medical record documentation can be uploaded. For more information, you can select the Frequently Asked Questions menu item in the CGMA by clicking on the question mark icon in the upper right corner of the screen.
9/2021Recall: Firvanq
Wilmington, MA, Azurity Pharmaceuticals Inc. (“Azurity”) is recalling one lot of Firvanq® (vancomycin hydrochloride for oral solution), Vancomycin 50 mg/mL Kit (“Firvanq®”) due to safety reasons. Firvanq is an antibiotic medication used to treat diarrhea caused by Clostridium difficile and enterocolitis (inflammation of the intestine caused by the bacterium Staphylococcus aureus). Read the full text of the Firvanq recall.
9/2021Recall: Lidocaine (Teligent)
Teligent is recalling one lot of Lidocaine Hydrochloride Topical Solution 4% (40 mg/mL), due to the lot being super-potent (higher than normal or acceptable potency). Lidocaine is a topical treatment used for pain relief. Read the full text of the Lidocaine (Teligent) recall.
9/2021E&M Documentation for Diagnosis Reporting
Join UPMC Health Plan's HCC Risk Adjustment Department's Marlana Tice, Program Director and Brenda Stevenson, Lead Physician Educator for a live CME-accredited* webinar on E&M Documentation for Diagnosis Reporting on Sept. 29, from noon to 1 p.m. Register for the webinar on E&M Documentation for Diagnosis Reporting today!

Providers can earn continuing medical education (CME) credits, and coders can earn 1.0 continuing education units (CEU) for attending this event.

*Provider is responsible for verifying CME eligibility.
9/2021Q3 Provider Directory Updates Required
We are reminding all providers that in order to comply with CMS/DHS/PID directives to maintain accurate directories. UPMC Health Plan Requires all providers to verify their Provider Directory information at least quarterly. It is critical for our members. The potential earnings through the Quality Partners Primary Care Incentive Program for CM and MC/SNP will only be available if directory information is verified quarterly.

UPMC Health Plan has contracted with Lexis Nexis to outreach via email & Online Portal, fax or phone to verify your provider information each quarter.

As the new quarter begins, you will be contacted by Lexis Nexis in the coming weeks ahead. We ask that you respond to this outreach and complete the attestation through the Lexis Nexis Portal as soon as practical. We ask that if possible, you respond within one to two weeks of being contacted.

Alternatively, please visit the Provider Directory and check that your provider information and office details are up to date and accurate. Please update it if needed.

Specifically, here is the information that must be reviewed/updated:

  • Ability to accept new patients
  • Street address
  • Phone number
  • Office hours
  • Hospital privileges
  • Any other information that affects your patient availability

You can view your information by searching the online directory for your name. Make updates to your information with the Change Provider Profile Info Form.

*If you have any questions on this matter or have trouble with your updates, please contact your physician account executive or contact Provider Directory Mgmt at ProviderDirectory@upmc.edu or by phone at 412-667-7876.

Thank you for your support in this ongoing effort!

*LexisNexis cannot change your current product participation, or the services contracted by your practice. For questions or concerns regarding product participation or contracted services, please contact your physician account executive.
9/2021Recall: Atovaquone
KVK Tech Inc. is recalling two lots of Atovaquone Oral Suspension due to complaints of unusual grittiness in the product, which is most likely due to exposure to extremely cold weather during shipment. Read the full text of the Atovaquone Oral Suspension recall.
8/2021Suicide prevention webinar now available
September is National Suicide Prevention Awareness Month—a time to reflect on the provider’s important role in this aspect of saving lives. Dr. Geoffrey Neimark and Lauren Marshall, MPW, present a non-CME educational offering that reviews information around suicide including epidemiology, risk and protective factors, and methods for screening and treatment. Sign in and watch the suicide prevention webinar now.
8/2021CGMA system update
An issue was discovered with processing negative eye exam claims for compliance in the Partners Program Gaps in Care (CGMA) system. UPMC Health Plan has received all eye exam claims submitted with a negative result this year through the system, and we are prioritizing the database fix to accurately close the gap. Users will see their appropriate status in the CGMA application after the system refresh in October.

We apologize for the inconvenience and appreciate your patience.
8/2021New lab benefit management program begins Oct. 1
On Oct. 1, UPMC Health Plan will implement a benefit management program to aid in the administrative application of medical policies for our laboratory claims.

If you provide laboratory services or refer patients to laboratories, please be aware that under this program, new medical policies and guidelines will affect payment for certain services, tests, and procedures. This will be true for all lines of business.

8/2021New policy MP.177 effective Oct. 1
Effective Oct. 1, 2021, UPMC Health Plan will implement a new policy: MP.177 Low-Value Services. MP.177 defines the criteria and indications for “low-value” services. UPMC Health Plan is committed to reducing unnecessary costs in the health care system that are the result of duplicative or medically unnecessary services.

“Low-value” care includes tests and procedures that should not be performed given their potential for harm, their unnecessary redundancy with prior testing, or the existence of comparably effective—and often less expensive—alternatives. A subspecialty society review in populating Choosing Wisely and CMS Low-Value Services identified these services as “low-value.” Reducing the use of these services is an opportunity to increase quality and lower costs.

The following services have limitations addressed in MP.177:

  • Annual Resting EKG (CPT 93000, 93005, 93010, 93015, 93016, 93017, and 93018)
  • EEG for Headaches (CPT 95812, 95813, 95816, and 95819)
  • Imaging for Eye Disease (CPT 92081, 92082, 92083, 92132, 92133, 92134, 92227, S3000)

You can find the complete list of MP.177 Low-Value Services in the redline draft version at upmchp.us/providerrldocs.

If you have questions regarding this information, contact your network manager or provider account executive. You can also call Provider Services at 1-866-918-1595.
8/2021Two important process changes effective Oct. 1, 2021
UPMC Health Plan is committed to streamlining and automating processes to improve operational efficiencies. As a result of this commitment, we will be implementing two important changes effective Oct. 1, 2021.

Discontinuation of pre-determination and ancillary services fax lines
Beginning Oct. 1, 2021, we will be discontinuing our fax lines for pre-determination (412-454-2057) and ancillary services (412-454-5255) in favor of InterQual Connect. Providers will be required to enter all prior authorization requests through Provider OnLine and the requests will be launched to InterQual Connect. If the customized criteria are met, the provider will receive an authorization in real time. If the request does not meet criteria, the authorization request will be forwarded to our Utilization Management team for review and processing—that is, following the current process. Should you need assistance with prior authorizations, please contact the Medical Management department at 1-800-425-7800 for help with the process or if you do not have access to the internet. You can also reach out to your physician account executive or Provider Services at 1-866-918-1595 with any other questions you may have.

Explanations of Payments
Beginning Oct. 1, 2021, UPMC Health Plan will no longer be mailing paper copies of Explanations of Payments (EOPs). Currently, EOPs are available through Provider OnLine for review.

You should also contact your OAA to make sure you are enrolled in electronic funds transfer (EFT). Enrolling in EFT will allow you to continue receiving reimbursement in a timely manner. Your reimbursement funds will be deposited directly into the bank account you choose.

You can log in to Provider OnLine at upmchealthplan.com/providers and submit all prior authorizations and view or print your EOPs. If you have forgotten your Provider OnLine user ID or need assistance registering as a first-time user, call our Help Desk at 1-800-937-0438.

Please feel free to reach out to your physician account executive for help finding online EOPs, setting up an EFT, or if you do not have access to the internet. Paper EOPs will be made available for those without access to the internet.
8/2021Reinstatement of member cost share for telehealth services
Since March 2020, UPMC Health Plan has waived all member cost sharing (deductibles, copays, coinsurance) for telehealth services to ensure that no member faced a barrier to accessing necessary care during the height of the COVID-19 public health emergency in our region. As hospitals and provider offices in our region have largely returned to normal operations, UPMC Health Plan will reinstate standard member cost share per the member’s plan benefit design for telehealth services effective Sept. 1, 2021.

If you are currently using telehealth with your patients, keep in mind that most UPMC Health Plan members will have cost-sharing that is the same or less than an in-person visit—our plans do not charge members more for using telehealth. This reinstatement will apply to all lines of business including UPMC for You, UPMC for Life, UPMC for Kids, and UPMC Community HealthChoices in addition to all Commercial Group, Individual, and other products.*

The only exception to this reinstatement of member cost share is for telehealth services for the diagnosis of suspected COVID-19 and ambulance telehealth services in lieu of transport during an emergency (911) dispatch. These services will continue to waive member cost share in these instances only. UPMC for Kids will reinstate member cost share for ambulance telehealth services unrelated to COVID-19 effective Oct. 4, 2021. Preventive services eligible to be provided via telehealth will continue to be covered without cost sharing.

You can find additional information on UPMC Health Plan’s COVID-19 special coverage in our COVID-19 FAQ and Appendix A COVID-19 Benefits and Cost Sharing document. Thank you for your enduring commitment to the care of our members throughout the COVID-19 public health emergency.

*While almost all of our individual and group plans include extensive telehealth benefits, some ASO/self-funded employer plans do not cover telehealth services.
8/2021Recall: Chantix (Pfizer)
Pfizer is recalling several lot numbers of Chantix 0.5 mg tablets, Chantix 1 mg tablets, and Chantix kit of 0.5 mg/1 mg, for safety reasons. Chantix is a treatment to help patients quit smoking and is intended for short-term use. Read the full text of the Chantix (Pfizer) recall.
7/2021How the Emergency Rental Assistance Program can help patients
The Emergency Rental Assistance Program (ERAP) is a new federal program that is designed to help Pennsylvanians avoid losing their home or utility service. It helps people who are having financial trouble because of COVID-19 pay for their rent and utilities.

Many Pennsylvanians may be eligible, and some could be your patients. People who are eligible for ERAP include those who pay rent on a residential property and meet other requirements related to their income and housing. The program is open right now and is accepting applications online through COMPASS or a County Assistance Office—note that some larger counties may not accept COMPASS applications.

Visit the Pennsylvania Department of Human Services ERAP page to learn more about ERAP and how this assistance opportunity could help your eligible patients.
7/2021New provider-focused site offers SDOH screening and intervention information
Our new provider website on social determinants of health (SDOH) offers information that can help you identify your patients’ needs, connect them with resources, and develop interventions.

When you visit the site, you can:

  • Learn more about SDOH and how they affect your patients’ lives.
  • Get information on implementing a SDOH screening at your clinic.
  • Learn to identify and leverage community resources.
  • View our SDOH billing guide.
  • Access a toolkit that can help you evaluate your success in addressing SDOH.

Visit upmchp.us/SDOHbillinguide to explore tools and resources that can help you address SDOH at your clinic.
7/2021Recall: Metformin ER (Viona)
Viona Pharmaceuticals Inc. is recalling two lot numbers of Metformin Hydrochloride Extended Release Tablets, USP, 750 mg, because of an impurity found in the products above levels established by the FDA. Read the full text of the Metformin ER (Viona) recall.
7/2021Mission of Mercy (MOM) Pittsburgh 2021 Dental Care Event
Are any of your patients in need of dental services? Let them know about this upcoming dental clinic where they may receive free care. The two-day event helps provide needed dental services to the underserved population in our region.

The event will take place on Oct. 22-23, 2021, at the David L. Lawrence Convention Center. Local dental professionals will donate their time, assisted by a host of clinical and nonclinical volunteers.

Please tell interested patients they can learn more at mompgh.org/patient-info.

Also, Mission of Mercy Pittsburgh needs volunteers. If you or anyone on your staff is interested, visit mompgh.org/volunteer.
6/2021Update on COVID-19 Vaccine from UPMC Health Plan
As of May 12, 2021, the U.S. Food and Drug Administration (FDA) authorized the use of the Pfizer-BioNTech vaccine in children between the ages of 12 and 15. The FDA previously authorized the vaccine for people 16 and older. Data shows the vaccine is safe in children 12 and older and is effective in preventing COVID-19. Read more about the FDA’s announcement on UPMC.com.

Please encourage your patients to get their COVID-19 vaccine as soon as possible. We can assist with locating a clinic or scheduling a COVID vaccine appointment today. Please instruct your patients to call their Health Care Concierge at 1-833-280-8510 (TTY: 711) Monday through Friday 7 a.m. to 7 p.m. and Saturday and Sunday from 8 a.m. to 5 p.m. or visit vaccine.upmc.com.

Additional COVID-19 Vaccine Resources
For current information about COVID-19, the vaccine, and helpful links and resources to share with your patients, visit:
For the most recent COVID-19 policy and billing updates from UPMC Health Plan, please read:
6/2021Recall: NP Thyroid
Acella Pharmaceuticals, LLC is recalling certain lots of 15 mg, 30 mg, 60 mg, 90 mg, and 120 mg of NP Thyroid®, Thyroid Tablets, USP [levothyroxine (T4) and liothyronine (T3)] due to it being subpotent (lower than normal or acceptable potency). Read the full text of the NP Thyroid recall.
5/2021COVID-19 Vaccine and Mammography Coverage
Patients who receive a screening mammogram shortly after receipt of a COVID-19 vaccine AND have an abnormal screening result due to swollen lymph nodes, UPMC Health Plan will waive member cost-sharing for a follow-up screening mammogram or ultrasound with their network provider when screening procedure codes are associated with an adverse vaccine reaction diagnosis (T50.B95A, T50.B95D, T50.B95S, T88.1XXA, T88.1XXD, T88.1XXS). Follow-up biopsies may be subject to additional clinical review to determine eligibility for this enhanced benefit. Only one follow-up screening will be permitted per benefit year. Coverage effective through July 20, 2021, so long as permitted under the current state and federal emergency declarations.

Our self-insured or ASO employer groups can opt out of this coverage. Coverage for out-of-network providers and facilities will follow standard rules under a member’s benefit plan, which may include higher cost-sharing or non-coverage.
5/2021Recall: Guanfacine Extended-Release 2 mg Tablets
Apotex Corp is recalling three (3) lot numbers of Guanfacine Extended-Release Tablets, NDC# 60505-3928-01, for safety reasons. Guanfacine extended-release tablets are used to treat Attention Deficit Hyperactivity Disorder (ADHD) and can be used with other stimulant medications. Read the full text of the Guanfacine Extended-Release recall.
5/2021How the American Recovery Act can help patients
The American Rescue Plan recently signed into law increases the amount of financial assistance available through Pennie (Pennsylvania’s new state-based health insurance marketplace) for customers in 2021 and 2022, improving access to coverage and care.

To make health care more accessible, Pennsylvania opened a COVID-19 Special Enrollment Period (SEP) that allows individuals to enroll in a plan until Aug. 15, 2021.

Visit pennie.com to learn more about Pennie and how it can help your patients get covered.
5/2021UPMC Presbyterian Hospital designated as a new Pituitary Tumor Center of Excellence with UPMC Health Plan
UPMC Health Plan is pleased to announce UPMC Presbyterian hospital as a newly accepted Center of Excellence in the Pituitary Tumor Center of Excellence program. This program is designed to promote high-quality outcomes and provide an optimal patient experience for UPMC Health Plan members in response to recently published Pituitary Society guidelines that demonstrated the need for Pituitary Tumor Centers of Excellence.

The UPMC Health Plan Pituitary Tumor Center of Excellence program recognizes only those surgical facilities and pituitary tumor physicians with the highest level of multidisciplinary specialty teams and technical capability. Both hospitals and pituitary tumor physicians must demonstrate high-level performance with a focus on optimal patient experience throughout the entire care process for the UPMC Health Plan member.

To learn more or if you are interested in learning how to become a Pituitary Tumor Center of Excellence, visit upmchp.us/pituitarytumorcoe.
5/2021DHS to reinstate PROMISe™ ID revalidation requirements for Medical Assistance providers
Effective June 1, 2021, the Department of Human Services (DHS) will reinstate provider revalidation requirements as applicable prior to the COVID-19 public health emergency for Medical Assistance providers.

Providers must submit PROMISe™ ID revalidation applications by the due dates indicated in 90-day and 30-day revalidation notices for revalidations due on and after June 1, 2021.

All claims for rendering, ordering, referring, or prescribing providers without an active PROMISe™ ID will be denied for claims related to coverage for UPMC for You Medicaid, UPMC for Kids CHIP, and UPMC Community HealthChoices patients.

For more information about the provider revalidation requirements, please see MA Bulletin 99-16-10 If you have questions, please call DHS at 1-800-537-8862 (option 2, option 4, option 2).
4/2021Complete the Disclosure of Ownership Form online
UPMC Health Plan is required to collect disclosure of ownership, controlling interest, and management information from providers that participate in any UPMC Health Plan network. We will be sending a letter requesting that you complete a web form that captures this information. You must complete and submit the web form within 30 days of the request. You can complete the web form now at https://upmchp.us/provider-disclosure-form. If you encounter issues with the web form or have questions, call Provider Services at 1-866-918-1595.
4/2021RxWell: Prescription-strength health
Whether your patients want to improve their emotional or physical health, RxWell has a path for them. Learn more about how RxWell can help you support your patients' health goals in the April Provider Partner Update.
4/2021UPMC Prescription for Wellness – Optimizing Physician-Prescribed Patient Engagement and Support
The Prescription for Wellness team is excited to announce the completion of our second Six Sigma project: "Optimizing Physician-Prescribed Patient Engagement and Support." Since Dec. 2019, our student team has partnered with key physician practices—in primary care, cardiology, and women’s health—to improve and optimize the functionality of the existing Prescription for Wellness order set.

Our revised order set further empowers and supports providers and engages their patients with their health, care-management, and decision-support needs. Key features, functions, and technical highlights of the new order set include:

  • Revisions to the order set reflect feedback from our physician stakeholders and represents the “voice of the customer,” which is core to Six Sigma.
  • A comprehensive and expanded menu of UPMC Health Plan resources to better meet patient/family needs:
    • "Advance care planning" is included under Shared Decision-Making Support.
    • Healthy Families coaching and pediatric case management are included under Pediatric Support.
    • Expanded prenatal and postpartum resources are included under Maternity Support.
    • Resources to support social determinants of health (education, transportation, housing, and food) are included under Patient/Family Support Services.


The enhanced order set went live on March 5, 2021. If you have any questions regarding the expanded list of resources or are interested in learning more about Prescription for Wellness, please contact Jamie Delu at RxforWellness@upmc.edu.
4/2021We've made our Explanation of Benefits more user-friendly
Our new Explanation of Benefits (EOB) layout is designed to help our UPMC for Life members easily follow, understand, and find the information they need without hassle. Read about the improvements to our EOB on page 17 of the April Provider Partner Update.
3/2021Oral Health With Pediatric Members (Recorded)
Watch UPMC Health Plan Program Director Jessica Rhodes host a webinar on improving oral health care for pediatric patients. During this hour-long session, we discussed strategies for increasing awareness and supporting the oral health of pediatric members, as well as services and resources available to providers and caregivers.

You may earn continuing medical education credits for watching this webinar.*



*Provider is responsible for verifying CME eligibility. This activity is approved for the following credit: AMA PRA Category 1 Credit™, ANCC. Other health care professionals will receive a certificate of attendance confirming the number of contact hours commensurate with the extent of participation in this activity.
3/2021Health and Wellness Items for Your UPMC for Life Patients
We’re sending your UPMC for Life Medicare patients a wellness care package to help them stay healthy this year. Care packages are expected to start arriving in early March. Here’s what’s included:
  • Tote bag
  • Blood pressure monitor
  • Digital thermometer
  • Face mask
  • Hand sanitizer
  • Pedometer
  • Pillbox
  • Nonslip socks

We’re encouraging UPMC for Life members to use the blood pressure monitor at home during telehealth or virtual appointments so they can easily share the results with providers during scheduled appointments.

Instructions for use will be included with the blood pressure monitor. We are encouraging members to reach out to their providers if they take readings between visits and have questions or concerns about the results.

A flier that explains each item will also be included with the care package. The content will vary based on plan type:

If you or your patients have questions, refer to our FAQ sheet.*

All Medicare and SNP members will get a care package with the exception of Supplement members, Select members, members who have asked not to receive promotional materials, and members in long-term care or nursing facilities.

If you have any questions, please contact your physician account executive or clinical improvement specialist. You can also call Provider Services at 1-866-918-1595.

*This FAQ is for reference only and should not be distributed to patients.
2/2021Recall: Enoxaparin Injections
Apotex Corp is recalling two batches of Enoxaparin Sodium Injection, USP due to a packaging error in some syringe barrels containing 150 mg/mL markings (corresponding to 120 mg/0.8mL strength) instead of 100 mg/mL markings (corresponding to 100 mg/mL strength) on the syringe barrel and vice versa. Read the full text of the Apotex Enoxaparin Injection recall.
2/2021Updated Coverage for Breast Cancer Screening and Imaging
On Jan. 1, 2021, UPMC Health Plan updated member cost sharing for MRIs and/or ultrasounds performed for breast cancer screening purposes in accordance with PA 2020 Act 52. There is no member cost share for preventive breast cancer screenings. View more details on the updated coverage for breast cancer screening and imaging.
2/2021Opportunities to Earn Continuing Medical Education (CME) Credits*
UPMC Health Plan is offering a series of CME-accredited webinars and podcasts. You can access these resources in the new CME presentations section of our website.

In 2021, we will also be offering live WebEx events for CME credit that allow participants to engage in discussion and ask questions. Register today for our first WebEx event of 2021, Oral Health With Pediatric Members,** on Feb. 24 from noon to 1 p.m.

Visit upmchp.us/event and click Register. You must register to attend the event. Please complete all required fields. You will receive an email confirming your registration.

*Provider is responsible for verifying CME eligibility.
**This activity is approved for AMA PRA Category 1 Credit™ and ANCC. Other health care professionals will receive a certificate of attendance confirming the number of contact hours commensurate with the extent of participation in this activity.
2/2021Important Update: InterQual Connect Implementation Date
SPECIAL NOTE: As of Feb. 8, 2021, the new implementation date for InterQual Connect will be March 22, 2021, instead of the previously communicated date of March 3, 2021.

UPMC Health Plan previously communicated that we would be implementing InterQual Connect® through Provider OnLine on Feb. 1, 2021. The date for the UPMC Health Plan implementation of InterQual Connect has been pushed back to March 22, but you can still begin preparing to use InterQual Connect by attending scheduled webinars, listening to recorded sessions, and reviewing supporting materials. Please go to upmchp.us/InterqualConnect to view the webinar schedule; additional information will be posted to this site and to Provider OnLine soon.

If you have any questions, please contact your physician account executive or call Provider Services at 1-866-918-1595.
1/2021Encourage Your UPMC for Life Patients to Get the Preventive Care They Need in 2021
Soon we will be mailing UPMC for Life members a preventive care checklist so they can keep track of their preventive care reward opportunities for 2021. And this year, we've increased the reward amount for their annual wellness visit to $30! Any UPMC for Life member who completes this visit by Dec. 31, 2021, will receive a $30 UPMC for Life Visa® Prepaid Card to use anywhere Visa debit cards are accepted. Members may also be eligible for additional rewards if they have gaps in one or more eligible preventive screenings and meet the criteria. You can help patients get their reward(s) sooner by submitting your claims promptly! See details in the latest issue of Provider Partner Update. Learn more in our preventive care incentive FAQ for providers.
1/2021UPMC for Life Removed Network Limitations for HMO Premier Rx Plans in 2021
Many of our current HMO Premier Rx plans were provider-specific plans (PSPs). That means these plans offer a limited network of participating providers that members can use for their care.

Effective Jan. 1, 2021, PSPs will only apply to members who live in Berks County and are enrolled in the HMO Rx, HMO Premier Rx, or PPO Rx Enhanced plan. All other UPMC for Life members will have access to the full UPMC for Life provider network!

This change is noted on the UPMC for Life HMO Premier Rx member ID cards. For all members (excluding those who live in Berks County and are enrolled in the plans listed above), the network name will read as UPMC Medicare Network. There will no longer be a Premier Medicare Network or UPMC/Excela Medicare Network.

Participating UPMC for Life providers can be in our online searchable provider directory. Feel free to share this link with your patients.
1/2021Recall: Anagrelide (Torrent)
Torrent Pharmaceuticals is recalling one lot of Anagrelide 1 mg capsules because of a dissolving quality issue found during routine quality testing. Anagrelide is used to treat a blood cell disorder called thrombocythemia. Read the full text of the Anagrelide (Torrent) recall.
1/2021Recall: Sildenafil (AvKare)
AvKare is recalling one lot of Sildenafil 100 mg tablets due to mispackaging issue with another medication, Trazodone 100 mg tablets. Sildenafil 100 mg is used to for the treatment of erectile dysfunction. Read the full text of the Sildenafil (AvKare) recall.
12/2020What You Need to Know About Coronavirus
UPMC Health Plan is actively monitoring the COVID-19 pandemic—including the vaccine. As you well know, this is a rapidly evolving situation, and we will continue to provide timely updates to our network providers regarding issues that affect you and our member-patients.

The COVID-19 vaccine has arrived at UPMC hospitals. Consistent with public health guidance, UPMC is first giving the vaccine to at-risk health care workers and residents of long-term care facilities. This staged delivery and prioritization for high-risk groups is being coordinated with the Pennsylvania Department of Health.

Your patients will likely have many questions for you regarding the vaccine. Please direct them to the UPMC website and the UPMC Health Plan COVID-19 website for the most up-to-date information.
12/2020Review Appendix A – COVID-19 Special Coverage and Payment Policy
Review our Appendix A - COVID-19 Special Coverage and Payment Policy for the latest policy updates.

2020 Announcements

12/2020Chlamydia Screening: A Call to Action Webinar Recording Available to Replay Now!
Watch Harold C. Wiesenfeld, MD, CM, host a webinar on chlamydia screenings. During the hour-long discussion we identified the local epidemiology of chlamydia infections, described the health consequences, and reviewed strategies to overcome barriers to screening. We also identified best practices to improve chlamydia screenings and presented information on the current regional chlamydia screening trends. You can also earn continuing medical education (CME) credits for watching the webinar.

Watch the webinar recording.
12/2020HMS Provider Education Webinars Are Now Available
HMS has engaged with UPMC Health Plan to perform Automatic Implantable Cardioverter Defibrillator (AICD), Place of Service (POS), Inpatient Rehabilitation Facility (IRF), and Readmission reviews. Providers can access pre-recorded training webinars on AICD, POS, IRF, and Readmission clinical claim reviews. These training webinars will help ensure that providers understand the audit and medical record submission process and will provide additional instructions on the best way to collaborate and communicate with HMS. HMS has created a dedicated email to answer questions related to the new programs or review process. You can email ProviderEdu@hms.com through Dec. 31, 2020. When using this email, please include “UPMC Health Plan” in the subject line. Any questions after Dec. 31, 2020, should be directed to the Provider Relations call center at 1-866-875-1749.

Recorded presentations:

UPMC Readmissions
Provider Outreach and Education_ UPMC Readmissions - Webinar (12.2020) on Vimeo

UPMC AICD
Provider Outreach and Education_ UPMC AICD - Webinar (12.2020) on Vimeo

UPMC IRF
Provider Outreach and Education - UPMC IRF - Webinar (12.2020) on Vimeo

UPMC POS
Provider Education Webinar- Place of Service Review (122020)1 on Vimeo
12/2020Introducing RxWell
Prescription-strength health

Over the past few months, you’ve likely become familiar with our Brain Manager mobile app—and it’s here to stay. However, Brain Manager is becoming RxWell.

RxWell will still offer techniques to help your patients build skills to support them in living their best life. This new-and-improved version builds on the successes of Brain Manager’s anxiety and depression programs and introduces a new track that deals with stress management—plus new features make using RxWell even easier for your patients. Of course, RxWell will still help patients solve problems, practice meditation techniques (e.g., deep breathing), and challenge their thought patterns so they are better equipped to self-manage these conditions.

  • Personalized tracks
    Patients will choose from three evidence-based programs—anxiety, stress, or depression—based on their needs.* RxWell will teach them mindfulness-based and cognitive behavioral therapy techniques that are tailored to their personal journeys.
  • Digital support from a health coach
    All users get access to the help and support of a UPMC Health Plan health coach who can assist them. Health coaches are there for users as they work through any challenges they encounter along the way—directly in the app.
  • Tracked progress
    Regular check-ins allow patients to identify patterns in their behavior, mood, and emotions over time.
  • No cost to patients
    We believe that good mental health improves physical well-being, but cost is often a prohibitive factor for patients. That’s why RxWell is offered to all UPMC Health Plan members at no cost.
Help your patients take the first step toward improving their mental health. Let them know they can download RxWell today from the Apple App Store or Google Play! All they need to get started is their UPMC Health Plan member ID.

Providers who use the UPMC version of Epic as their EMR can prescribe RxWell to patients right from the Epic Dashboard. When you prescribe RxWell for patients, you can monitor their use of the app. Learn more about prescribing RxWell through Epic.

Additional RxWell provider resources

*RxWell is not a crisis service. It is a tool that your patients age 18 and older can download and use at their convenience.
12/2020Good Health, Better World
UPMC Health Plan has launched a podcast that will explore how our society affects our health. Factors like access to employment, housing, and transportation are commonly called the social determinants of health. Hosted by Dr. Ellen Beckjord, AVP, Population Health and Clinical Transformation at UPMC Health Plan, the episodes feature conversations with community leaders, government officials, and UPMC Health Plan experts.

To access episodes, visit the Good Health, Better World podcast.

Date available The conversation Guests
Episode #1: 12/08/20 Improving health as a community Fr. Paul Abernathy, CEO, Neighborhood Resilience Project
Ray Prushnok, AVP Programs and Executive Director, UPMC Center for Social Impact
Episode #2: 12/15/20 Connecting to the social safety net Julie DeSeyn, Chief Program and Policy Officer, United Way of Southwestern Pennsylvania
Dan Swayze, DrPH, MBA, MEMS, VP Community Services, UPMC Health Plan and Director of Operations, UPMC Innovative Home Care Solutions
Episode #3: 12/22/20 Better jobs, better health Sec. Teresa Miller, Pennsylvania Department of Human Services
Earl Buford, CEO, Partner4Work
Dan LaVallee, Director, UPMC Center for Social Impact
Episode #4: 1/4/21 How a home helps your health Everett McClevan, CEO Community Human Services
John Lovelace, President, Government Programs, UPMC Health Plan
12/2020Chlamydia Screening: A Call to Action Webinar Recording Available to Replay Now!
Watch Harold C. Wiesenfeld, MD, CM, host a webinar on chlamydia screenings. During the hour-long discussion we identified the local epidemiology of chlamydia infections, described the health consequences, and reviewed strategies to overcome barriers to screening. We also identified best practices to improve chlamydia screenings and presented information on the current regional chlamydia screening trends. You can also earn continuing medical education (CME) credits for watching the webinar.

Watch the webinar recording.
11/2020UPMC Health Plan Provider Services Holiday Hours
We would like to let you know that our Provider Services center will be closed on Thanksgiving, Christmas, and New Years Day.
11/2020UPMC Health Plan Implementing InterQual Connect to Automate Prior Authorization Reviews
UPMC Health Plan is excited to announce that we will implement InterQual Connect® on Feb. 1, 2021, to automate medical prior authorization reviews for codes not currently managed by HealthHelp. Medical prior authorization requirements and criteria are unchanged. InterQual Connect has been customized to align with UPMC Health Plan's Medical Prior Authorization policies.

When InterQual Connect is implemented, providers will enter prior authorization requests through Provider OnLine and the requests will be launched to InterQual Connect. If the criteria are met, the provider will receive an authorization in real time. If the request does not meet criteria, the authorization request will be forwarded to the Utilization Management Team for review just as it is today.

What providers can expect:
  • Before you begin to enter the request information, you will have the ability to query the system to determine if a prior auth for the CPT code is required.
  • Clinical information will be entered and can be uploaded into InterQual Connect.
  • You can review the status of an authorization through Provider OnLine in the Auth Entry/Inquiry tab.
  • HealthHelp and pharmacy prior authorization requirements are unaffected and will continue to follow the current submission and review processes.

Important note: The requirement for prior authorizations for Home Health Services, which had previously been suspended, will be reimplemented on Feb. 1, 2021, with additional details to follow.

Contact your physician account executive for help with the process or if you do not have access to the internet. You can also reach out to Provider Services at 1-866-918-1595 with any other questions. Training and supporting materials will be available on Provider OnLine in the upcoming weeks.
11/2020Recall: Paroex Chlorhexidine Gluconate Oral Rinse USP, 0.12% (Sunstar – Oct.)
Sunstar Americas Inc. (SAI) is recalling Paroex® Chlorhexidine Gluconate Oral Rinse USP, 0.12% bearing an expiration date from 6/30/22 to 9/30/22 due to possible contamination with bacteria. This medication is used for the treatment of gingivitis (a gum disease). Read the full text of the Paroex Chlorhexidine Gluconate Oral Rinse recall.
11/2020Recall: Metformin ER (Nostrum)
Nostrum Laboratories Inc. is recalling multiple lots of Metformin Hydrochloride Extended Release Tablets, USP, 500 mg and 750 mg because of an impurity found in the products above levels established by the FDA. Metformin HCl ER tablets are used to improved blood sugar in adults with type 2 diabetes. Read the full text of the Metformin ER (Nostrum) recall.
11/2020Partners Program Gaps in Care (CGMA) Notification Center
We want you to know that the new Partners Program Gaps in Care (CGMA) capability, which instantly notifies you of important care gap and member roster status change events, is now available. These notifications will include letting you know when care gap submissions or member roster change requests submitted by you have been returned to you for further action. For more information, review our training video or FAQ document.
11/2020SNP Plan Name Change
UPMC for Life has updated our HMO SNP plan name, UPMC for Life Dual, to UPMC for Life Complete Care (HMO SNP). Our new name reflects the whole-person care and security we provide to all of our members! Members will get the same great benefits and access to high-quality care that they have always enjoyed. We will mail current members about the change to their plan name in October. The name change will take effect Jan, 1, 2021. Sample ID cards are available for your review.
11/2020Pulmonary Rehabilitation Locations for Your COPD Population
Many treatment options are available for patients with COPD; pulmonary rehabilitation is one strategy that may be ideal for your patients. Studies show that early use of pulmonary rehabilitation after hospitalization for a COPD exacerbation is associated with increased survival at one year compared with initiation after 90 days or not at all.1 This often-underutilized program can reduce patients’ symptoms, increase their ability to participate in daily activities, and improve their quality of life.

UPMC contracts with many pulmonary rehabilitation locations throughout our service area. Once you’ve referred your patient, they can schedule an appointment at the location that is most convenient for them.

You can find a complete list of UPMC Health Plan in-network pulmonary rehabilitation sites at upmchp.us/PRadultsites.

For more information about UPMC’s pulmonary rehabilitation program, visit upmc.com/services/pulmonology/our-services/respiratory/services/pulmonary-rehab.

Source:
Lindenauer PK, Stefan MS, Pekow PS, et al. Association between initiation of pulmonary rehabilitation after hospitalization for COPD and 1-year survival among Medicare beneficiaries. JAMA 2020;323(18):1813-1823.
10/2020Human Papillomavirus Diseases, Vaccination, and Your Healthcare Provider Superpower
Learn about the importance of timely HPV immunizations and how to confidently recommend them. Please view Dr. Todd Wolynn’s recorded HPV presentation, Human Papillomavirus Diseases, Vaccination, and Your Healthcare Provider Superpower. Dr. Wolynn is a pediatrician and CEO at Kids Plus Pediatrics in Pittsburgh, Pennsylvania.

This presentation offers an opportunity to review epidemiology and outcomes of HPV infection, including trends in HPV-related cancers. Learn about the importance of HPV vaccination for cancer prevention; possible changes to HPV vaccine recommendations; and recent uptake, safety, and impact data. Earn Continuing Medical Education (CME) credits.*

*In support of improving patient care, the University of Pittsburgh is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the health care team.

Physician (CME)
The University of Pittsburgh designates this enduring material activity for a maximum of 1.0 AMA PRA Category 1 Credits.* Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nursing (CNE)
The maximum number of hours awarded for this Continuing Nursing Education activity is 1.0 contact hours.
10/2020Recall: Metformin (Marksans Pharma - Oct.)
Marksans Pharma Limited, India, is recalling multiple lots of metformin hydrochloride extended-release tablets, USP, 500 and 750 mg, because of an impurity found in the products above levels established by the FDA. Metformin HCl ER tablets are used to improve blood sugar in adults with type 2 diabetes. Read the full text of the Marksans Pharma metformin recall.
10/2020Notice: ONAF Submission Updates
Beginning November 14, Optum OB Care will be making system updates to their platform. Learn more about the Optum OB Care updates.
10/2020Recall: NP Thyroid (Acella – Sept)
Acella Pharmaceuticals LLC is recalling one lot of 15 mg (Lot # M327E19-1) and one lot of 120 mg (Lot #M328F19-3) NP Thyroid®, Thyroid Tablets, USP [levothyroxine (T4) and liothyronine (T3)] due to it being subpotent (lower than normal or acceptable potency). Read the full text of the NP Thyroid recall.
10/2020UPMC for Life updates for 2021
Get the latest on UPMC for Life plan improvements, changes, and more—including:

Learn more in October's Provider Partner Update.
9/2020Recall: Nature Thyroid and WP Thyroid
RLC Labs, Inc. is recalling 483 lots of Nature-Thyroid® and WP Thyroid® due to it being subpotent (lower than normal or acceptable potency). Nature-Thyroid and WP Thyroid are used for hypothyroidism (underactive thyroid). Read the full text of the Nature Thyroid and WP Thyroid recall.
9/2020Mandatory Training for Medicare SNP Providers
The Centers for Medicare and Medicaid Services (CMS) require all Medicare Special Needs Plan (SNP) providers to complete the Model of Care Training. The Model of Care describes the structure and process by which health care services are delivered to SNP members.

For your convenience, UPMC Health Plan has developed a brief online training module on the Model of Care for our SNP product, UPMC for Life Complete Care (HMO-SNP) (formerly known as UPMC for Life Dual).

To complete the training, go to upmchp.us/snp-moc-2020. You will need your tax identification number to sign up.

If you have any questions or concerns, feel free to contact your physician account executive or call Provider Services at 1-866-918-1595.

Thank you for your continued support and the care you provide for our members!
9/2020CGMA Announcement
UPMC Health Plan has encountered an unexpected delay processing blood pressure claims for the Partners Program Gaps in Care (CGMA) system. Please be assured we have received all blood pressure claims submitted this year through this system and are prioritizing a resolution to accurately close the gap. All users will receive a notification when the issue has been corrected. At that time, appropriate reporting and status will be accessible within CGMA.

We apologize for the inconvenience and appreciate your patience.
9/2020Update on Member Cost Share for Colorectal Cancer Screenings
UPMC Health Plan is making colorectal cancer (CRC) screening easier and more accessible for our members. We are changing our billing procedures for UPMC Health Plan members who complete a fecal test with a positive result necessitating a follow-up colonoscopy. Learn about the adjustments in our billing guide and provider newsletter.
9/2020New Prior Authorization Forms for Continuous Glucose Monitors available for All Lines of Business
Continuous Glucose Monitors
9/2020Coverage of Telehealth Well-Child Visits
The COVID-19 pandemic has led to unprecedented social distancing measures. These guidelines have encouraged people to avoid leaving their homes except for essentials like groceries or urgent medical care. As such, many parents are postponing pediatric well-visits.

As indicated by the American Academy of Pediatrics (AAP) and Bright Futures periodicity schedule, UPMC Health Plan recommends that children covered by UPMC for Kids, UPMC for You, and Commercial plans see their PCP in person for annual well-visits. However, in light of current social distancing guidelines, UPMC Health Plan will consider well-child visits done via telehealth and conducted in a way that optimizes care delivery as valid well-child visits.

UPMC Health Plan will cover telehealth well-child visits for pediatric members of UPMC for Kids, UPMC for You, and Commercial plans in accordance with AAP and Bright Futures recommendations. Coverage varies based on the need for in-person well-child testing.

UPMC Health Plan has developed billing guides to assist providers in administering and billing compliant telehealth well-child visits:

EPSDT Telehealth Billing Guide
Commercial and UPMC for Kids Billing Guide

If you have any questions please contact your physician account executive or call Provider Services at 1-866-918-1595.

Note for all billing guidance for EPSDT: The EP modifier must still be placed first for EPSDT billing consideration.

Remember, these steps are not intended to supersede your preferred methods of care delivery and the provider is responsible for the appropriate billing of services.
9/2020Recall: Metformin ER (Bayshore Pharmaceuticals LLC)
Bayshore Pharmaceuticals LLC is recalling one lot of metformin HCL ER tablets, USP, 500 mg, and one lot of metformin HCL ER tablets, USP, 750 mg, because of an impurity found in the products above levels established by the FDA. Read the full text of the Bayshore Pharmaceuticals LLC Metformin ER recall.
8/2020AnywhereCare Virtual Visit
UPMC AnywhereCare, UPMC Health Plan’s telemedicine tool, offers a convenient and easy way for patients to get a medical evaluation from home or the office if they are having common conditions like a cold or sore throat, or think they are experiencing COVID-19 symptoms. Patients can have a virtual visit with a UPMC provider right from their smartphone, tablet, or computer in minutes.* Children up to age 17 can be seen by pediatric providers from UPMC Children’s Hospital of Pittsburgh.** UPMC Health Plan Members pay a $0 visit copay until Sept. 30, 2020.† AnywhereCare is available 24/7 and providers can send prescriptions to the patient’s preferred pharmacy, if needed. UPMC AnywhereCare can provide general medical advice, plus treat the following conditions and more:
  • Bronchitis and coughs
  • Cold and flu symptoms
  • Diarrhea
  • Pink eye
  • Rashes
  • Seasonal allergies
  • Sinus infections
  • Tick bites
  • Vaginal yeast infections

Patients can sign up for UPMC AnywhereCare by visiting anywherecare.upmc.com or downloading the UPMC AnywhereCare app from the Apple App Store or Google Play Store.

*UPMC Health Plan members located in Pennsylvania at the time of virtual visit may select a UPMC-employed provider or a provider from Online Care Network II P.C. (OCN), subject to availability and discretion of the provider. Members located outside of Pennsylvania will receive service from OCN. OCN is not an affiliate of UPMC.

**UPMC Children’s AnywhereCare is available only to patients who are in Pennsylvania. In order for a child to have a UPMC Children’s AnywhereCare visit, the child’s parent or legal guardian must be with the child during the video portion of the visit, and the child and parent or legal guardian must be in Pennsylvania during the visit. Members located outside of Pennsylvania at the time of service may select the standard UPMC AnywhereCare module and will receive care from a provider employed or contracted by Online Care Network II P.C. (OCN) at the discretion of the provider. OCN is not an affiliate of UPMC.

†Limitations may apply for members of self-funded (ASO) plans that have opted out of coverage.
8/2020LAST CHANCE! Reminder to Encourage Members to Get Preventive Screenings
We would like to remind you of our preventive screening incentive program for your patients enrolled in a UPMC for Life plan. Members who meet the eligible HEDIS criteria and complete certain preventive services between January 1, 2020, and December 31, 2020, can receive a UPMC for Life Visa® Prepaid Card.* This card can be used everywhere that Visa debit cards are accepted. View a flier that explains the program and who qualifies. We hope you will encourage eligible UPMC for Life members to participate!

*Card is issued by MetaBank®, member FDIC, pursuant to a license from Visa USA Inc. No cash access or recurring payments. Can be used everywhere Visa debit cards are accepted. Card valid for up to six months, funds do not expire and may be available after card expiration date, fees may apply. Card terms and conditions apply.
8/2020Recall: DDAVP (Ferring–August)
Ferring Pharmaceuticals US is recalling all lots of DDAVP® Nasal Spray 10 mcg/0.1 mL, Desmopressin Acetate Nasal Spray 10 mcg/0.1 mL, and STIMATE® Nasal Spray 1.5 mg/mL because these lots are superpotent (above normal or acceptable potency). These products are used to control fluids and treat some blood disorders. Read the full text of the DDAVP (Ferring - August) recall.
8/2020August 26: Join a Live Presentation on HPV Diseases and Vaccination
Pediatrician Todd Wolynn will discuss HPV and related diseases and recommendations on HPV vaccines from the Advisory Committee on Immunization Practices. Learn about the importance of timely HPV immunizations and earn CME* credits.

Tune in to Dr. Wolynn's presentation on Wednesday, August 26 from noon to 1 p.m. Register today at https://upmchp.us/hpv.

*This activity is approved for the following credit: AMA PRA Category 1 Credit™, and ANCC. Other health care professionals will receive a certificate of attendance confirming the number of contact hours commensurate with the extent of participation in this activity.
8/2020UPMC Health Plan Now Offers a Pain Management Consultation Line for Physicians Across Pennsylvania Treating Our Members
Provider pain management consultation letter

Provider pain management consultation flier
8/2020Recall: Daptomycin (Mylan—July)
Mylan is recalling one lot (# 7605112) of daptomycin for injection, 500 mg/vial, due to particulate matter being found in one single-dose vial. Read the full text of the Mylan Daptomycin recall.
7/2020Provider Relief Fund Application Process
The U.S. Department of Health and Human Services (HHS), through the Provider Relief Fund (PRF), is distributing $15 billion to eligible Medicaid, CHIP, and dental providers. If you are a provider who is interested in learning about the application process for the PRF, you can visit www.hhs.gov/coronavirus/cares-act-provider-relief-fund for the latest information and updates.
7/2020Recall: Metformin ER (Lupin2) (Lupin Pharmaceuticals Inc.)
Lupin Pharmaceuticals Inc. is recalling all lots of Metformin Hydrochloride Extended Release Tablets, USP, 500 mg and 1000 mg, because of an impurity found in the products above levels established by the FDA. Read the full text of the Lupin Pharmaceuticals Inc. recall.
7/2020Recall: Metformin ER (Granules Pharmaceuticals Inc.)
Granules Pharmaceuticals Inc. is recalling 12 lots of Metformin HCL ER Tablets, USP, 750 mg, because of an impurity found in the products above levels established by the FDA. Read the full text of the Granules Pharmaceuticals Metformin ER recall.
7/2020UPMC Announces Patient-centered Initiative to Reduce Out-of-Pocket Prescription Drug Costs for UPMC Health Plan Members
Read the full press release.
7/2020EPSDT Periodicity Schedule Update
The EPSDT Periodicity Schedule has been updated to reflect the changes made by DHS Bulletin 99-20-04 on May 26, 2020.
7/2020Reminder to Encourage Members to Get Preventive Screenings
We would like to remind you of our preventive screening incentive program for your patients enrolled in a UPMC for Life plan. Members who meet the eligible HEDIS criteria and complete certain preventive services between January 1, 2020, and December 31, 2020, can receive a UPMC for Life Visa® Prepaid Card.* This card can be used everywhere that Visa debit cards are accepted. View a flier that explains the program and who qualifies.

We hope you will encourage eligible UPMC for Life members to participate!

*Card is issued by MetaBank®, member FDIC, pursuant to a license from Visa USA Inc. No cash access or recurring payments. Can be used everywhere Visa debit cards are accepted. Card valid for up to six months, funds do not expire and may be available after card expiration date, fees may apply. Card terms and conditions apply.
6/2020Update Your Profile With Demographic Information About Providers in Your Office
You can now give racial, ethnic, and linguistic information about providers in your office on the Provider Change Form (under the Update Race/Ethnicity and Language Information section). While providing this information is voluntary, it can help accommodate increasingly diverse patient populations who may face disparities in health care because of language and other related barriers. For example, giving patients the option to connect with providers who speak their first language can help them feel comfortable and make more informed decisions about their care.* Language and language service information will still be available through UPMC Health Plan’s provider directory. However, demographic information will only be made available to individual members upon request.

*Mullins CD, Blatt L. Health disparities: A barrier to high-quality care. Am J Health Syst Pharm. 2005 September 15; 62(18):1873–18.doi: 10.2146/ajhp050064
6/2020Dr. Schuster's and Dr. Hurford's Viewpoint: Addressing the Mental Health Impact of COVID-19
Dr. Schuster and Dr. Hurford recently co-authored an article on mental health and how it has been affected during the COVID-19 pandemic. Read the full article on Dr. Schuster's and Dr Hurford's discussion.
6/2020Telehealth Well-Child Visits
UPMC Health Plan covers telehealth well-child visits for pediatric members of UPMC for Kids, UPMC for You, and commercial plans in accordance with American Academy of Pediatrics and Bright Futures recommendations. Coverage varies based on the need for in-person well-child testing. Further coverage guidance will be provided in the coming weeks to help providers make determinations regarding appropriate types of visits.
6/2020Recall: Metformin ER (Marksans Pharma)
Marksans Pharma Limited, India, is recalling all lots of metformin hydrochloride extended-release tablets, USP, 500 mg, because of an impurity found in the products above acceptable levels established by the FDA. Read the full text of the Marksans Pharma Metformin ER recall.
6/2020Recall: Metformin ER (Teva)
Teva Pharmaceuticals USA Inc. is recalling 14 lots of metformin hydrochloride extended-release tablets, USP, 500 mg and 750 mg, because of an impurity found in the products above the acceptable levels established by the FDA. Read the full text of the Teva Pharmaceuticals Metformin ER recall.
6/2020Equitable access to patient-centered, high-quality health coverage and health care
We are aware that on June 12, 2020, HHS announced modifications to the 2016 rule implementing Section 1557 of the Affordable Care Act that, among other things, remove protections against discrimination in health coverage based on sex stereotyping and gender identity. We at the UPMC Insurance Services Division believe that every individual deserves to have equitable access to patient-centered, high-quality health coverage and health care that is provided with dignity and respect. Our commitment to nondiscrimination will not change based on the weakening of Section 1557 or the narrowing of sex- and gender-related regulatory protections. We will continue in our ongoing efforts to establish, maintain, and reinforce dignity, respect, and equality for all of our members. Toward this end, we will continue to apply coverage terms and member cost sharing equally and without regard for gender identity or gender expression. The rule will not change our existing coverage policies for gender-affirming procedures and related health services for our insurance members. In short, the UPMC Insurance Services Division will continue to do everything it can to ensure that all members continue to have access to the care and coverage they need.
6/2020UPMC Health Plan Extends Members' No-cost Access to Telehealth Services
Until September 30, 2020, UPMC Health Plan will waive all member cost sharing—including deductibles and copayments— for covered services provided via telehealth with in-network providers.* This also applies to telehealth services from UPMC AnywhereCare, FQHCs, and RHCs. UPMC Health Plan requests that POS 02, modifier 95, or both be included with all telehealth visits for any UPMC Health Plan member claim to ensure appropriate processing of $0 member cost sharing.

This extension until September 30, 2020, applies to individuals enrolled in UPMC Health Plan’s fully-insured commercial group coverage, individual ACA Marketplace plans, UPMC for Kids, and our UPMC for Life Medicare Advantage plans.

UPMC Health Plan’s technical requirements and information on covered telehealth services can be found in UPMC Health Plan policy MP.148, which is available online through our Policies and Procedures Manual. Temporary changes to our telehealth coverage policy can be found in Appendix A – COVID-19 Special Coverage and Payment Policy.

*While almost all of our individual and group plans include extensive telehealth benefits, some ASO/self-funded employer plans do not cover telehealth services. Coverage of some services may be limited following the end of the national COVID-19 emergency period.
6/2020Recall: Metformin ER (Apotex)
Apotex Corp. is recalling all lots of metformin hydrochloride extended-release tablets, USP, 500 mg, because of an impurity found in the products above the acceptable levels established by the FDA. Read the full text of the Metformin ER (Apotex) recall.
6/2020Appendix A – COVID-19 Special Coverage and Payment Policy Updates
UPMC Health Plan had temporarily extended the timely filing requirement for administrative and medical necessity provider appeals. The timely filing requirement was extended from within 30 business days of the initial denial notification to within 60 business days of the initial denial for the dates of 3/15/20 – 6/15/20. This appeals extension will end on 6/15/20. For coverage decisions made on or after 6/15/20, standard filing timelines will apply.
6/2020Recall: Metformin ER (Amneal)
Amneal Pharmaceuticals LLC is recalling all lots of metformin hydrochloride extended-release tablets, USP, 500 mg and 750 mg, because of an impurity found in the products above the acceptable levels established by the FDA. Read the full text of the Metformin ER (Amneal) recall.
6/2020Recall: NP Thyroid
Acella Pharmaceuticals LLC is recalling several lots of NP Thyroid, which have been deemed superpotent. Read the full text of the recall.
6/2020CGMA Announcement
There is a new feature in the CGMA that will allow record transfer uploads to support the removal of members from the member roster. The documents can be uploaded under the current “Verify Patient Affiliation” option by selecting “Patient is seeing a Primary Care Physician at a different office,” then choosing “YES” under "Medical Record Transfer Documentation." The documentation must include Authorization for Release of Protected Health Information, including the signature of the patient or parent/legal guardian, if the patient is younger than age 18. The name of the provider to whom the Protected Health Information is released should also be documented. Please see the FAQ within the CGMA on the provider portal documents and forms "Provider Training" section for additional information.
6/2020UPMC Health Plan Extends Members’ No-cost Access to Telehealth Services
Read the full details in our latest press release. UPMC Health Plan requests that POS 02 or modifier 95 (with any other appropriate POS) be included with all telehealth visits for any UPMC Health Plan member claim to ensure appropriate processing of $0 member cost sharing.
6/2020Medical Policy Pulled: MP.159
MP.159 was recently pulled for further consideration by multiple stakeholders that may necessitate policy refinement. More information will be posted as it becomes available.
5/2020Recommendations for Completing Medicare Annual Wellness Visits Via Telehealth
UPMC Health Plan is prioritizing the health of our Medicare members through the Medicare annual wellness visit (AWV). The AWV is integral to our members’ health because it can be used as an opportunity for gap closure. Conveniently for Medicare members, AWVs can be conducted through telehealth.

We have developed a complimentary AWV booklet and webinar to assist providers in administering and billing compliant AWVs:

Remember, these steps are not intended to supersede your preferred methods and the provider is responsible for the appropriate billing of services. You are not required to use our resource material, but it is intended to support accurate Medicare AWV documentation.

Additionally, we recognize that some Medicare and SNP members may not have video capability. In these cases, AWVs can be conducted via audio. Per CMS guidelines, an HCC screening can only be captured using synchronous audio and video. As a best practice, UPMC Health Plan is recommending that telehealth AWVs be conducted via real-time synchronous audio and video. If the AWV is audio-only, be sure to schedule an in-person AWV to capture HCCs and other screenings such as BMI, blood pressure, and HbA1C.
5/2020IMPORTANT: ALL NETWORK PROVIDERS
UPMC Health Plan is enhancing its existing claims editing procedure to improve claims processing accuracy. The effective date was previously communicated as April 1, 2020, but due to COVID-19 the go-live date was changed to June 15, 2020. Beginning June 15, 2020, UPMC Health Plan will closely review claims that have been billed with certain modifiers. These modifiers are sometimes used incorrectly to override unbundling edits. Specifically, modifier 25 should only be used to indicate separately identifiable E/M services, and modifiers 59, XE, XS, XP, and XU should only be used to indicate that a procedure or service is distinct or independent from other services performed on the same day. To align with industry standard coding guidelines and modifier descriptions, UPMC Health Plan’s review will use nationally sourced guidelines to determine the appropriateness of a modifier used to bypass code edits. This enhanced editing process will provide claim adjudication that more closely aligns with coding guidelines.
5/2020Update: SEP for those affected by COVID-19
On Tuesday, May 5, 2020, CMS released a memo announcing that there is a Special Enrollment Period (SEP) available nationwide to individuals who have been affected by COVID-19. To qualify for this special enrollment period the below criteria must be met.

An SEP exists for individuals affected by a major disaster who were unable to and did not make an election during another valid election period. This includes both enrollment and disenrollment elections.

Individuals will be considered “affected” and eligible for this SEP if they:

  • Reside, or resided at the start of the incident period, in an area for which FEMA has declared an emergency or a major disaster and has designated affected counties as being eligible to apply for individual or public level assistance;
  • Had another valid election period at the time of the incident period; and
  • Did not make an election during that other valid election period.

In addition, the SEP is available to those individuals who do not live in the affected areas but rely on help making health care decisions from friends or family members who live in the affected areas.

The SEP is available from the start of the incident (March 1) and for four full calendar months after the start of the incident period (June 30).

Individuals will be given one opportunity to make that missed election and will not be expected to provide proof that they were affected by the pandemic-related emergency.

Read the full announcement from CMS.
5/2020Encourage your UPMC for Life patients to complete their annual wellness visit from home
Through telehealth video visits, your patients can complete an annual wellness visit and talk with a doctor or provider face-to-face to get medical care and advice.

Until June 15, all UPMC for Life members have a $0 copay for telehealth services. Plus, if they complete an annual wellness visit by December 31, they will receive a $20 UPMC for Life Visa® Prepaid Card to use anywhere Visa debit cards are accepted.

Once your patients complete their annual wellness visit through telehealth and you submit a claim, it may take up to 32 days for them to receive their reward in the mail. You can help your patients get their reward sooner by submitting your claims promptly!

If you have any questions about telehealth or the preventive care rewards program, please contact your physician account executive or call Provider Services at 1-866-918-1595.

Card is issued by MetaBank®, N.A., Member FDIC, pursuant to a license from Visa U.S.A. Inc. No cash access or recurring payments. Can be used everywhere Visa debit cards are accepted. Card valid for up to 6 months, funds do not expire and may be available after card expiration date, fees may apply. Card terms and conditions apply.
5/2020Recall: Ketorolac Tromethamine Injection
Fresenius Kabi USA LLC is recalling numerous lot numbers of Ketorolac Tromethamine Injection due to the presence of particulate matter found in sample vials. Read the full text of the recall.
5/2020Recall: Tetracycline Capsules
Avet Pharmaceuticals Inc. is recalling numerous lot numbers of Tetracycline HCl Capsules, 250 and 500 mg, because of low amounts of tetracycline. Read the full text of the recall.
5/2020Recall: Nizatidine Oral Solution
Amneal Pharmaceuticals LLC is recalling three lots of Nizatidine Oral Solution, 15 mg/mL (75 mg/5 mL), because of an impurity found in the products above acceptable levels established by the FDA. Read the full text of the recall.
4/2020Most Recent FQHC/RHC Telehealth Guidance
We know you have many questions regarding telehealth services available to UPMC Health Plan members during the COVID-19 public health emergency (PHE). Federally Qualified Health Centers, Look-A-Like, and Rural Health Clinics can read more about our telehealth guidance.
4/2020Announcing UPMC Children's AnywhereCare
UPMC Health Plan’s telemedicine service—UPMC AnywhereCare—has expanded to offer care to children of all ages.

With UPMC Children’s AnywhereCare, children up to age 17 can have Virtual Urgent Care visits 24/7 with UPMC Children’s Hospital of Pittsburgh providers over live video. All your patients need is a smartphone, tablet, or computer.

UPMC Health Plan will waive all cost-sharing—including copays and deductibles—until June 15, 2020, for UPMC Health Plan members who use this service.*

UPMC Children’s AnywhereCare allows children to get medical attention quickly and safely from their home. Providers can screen children who may have been exposed to COVID-19, and they can provide treatment for these and other conditions commonly treated by a pediatrician or urgent care provider:
  • Bronchitis and coughs
  • Cold and flu symptoms
  • Diarrhea
  • Pink eye
  • Rashes
  • Sinus infections
  • Tick bites
  • Urinary tract infections

UPMC Children’s AnywhereCare is available only to patients who are in Pennsylvania.** Patients who are 3 or older can also use the standard UPMC AnywhereCare service if they need medical assistance.

We hope you will tell your patients or their parents about this convenient care option. Remember, UPMC Health Plan members can have no-cost visits through June 15. Patients who are not UPMC Health Plan members can still use UPMC Children’s AnywhereCare when they are in Pennsylvania; however, they will be charged $59 for their visits.

Patients or their parents can sign up for UPMC Children’s AnywhereCare by visiting anywherecare.upmc.com or downloading the app from the Apple App Store or Google Play.

*While almost all of our individual and group plans include extensive telehealth benefits, some ASO/self-funded employer plans do not cover telehealth services.

**UPMC Children’s AnywhereCare is available only to patients who are in Pennsylvania. In order for a child to have a UPMC Children’s AnywhereCare visit, the child’s parent or legal guardian must be with the child during the video portion of the visit, and the child and parent or legal guardian must be in Pennsylvania during the visit. If you are located outside of Pennsylvania at the time of service, you may select the standard UPMC AnywhereCare module and you will receive care from a provider employed or contracted by Online Care Network II PC (“OCN”) at the discretion of the provider. OCN is not an affiliate of UPMC.
4/2020Market withdrawal: Ranitidine (Zantac) products
The U.S. Food and Drug Administration (FDA) has requested that all manufacturers of ranitidine products withdraw the drug from the U.S. market because of an impurity found in the products above levels established by the FDA. The impurity is a chemical called N-Nitroso dimethylamine (NDMA) and it is a probable human carcinogen. Read the full text of the withdrawal.
4/2020Staying in Touch
UPMC Health Plan’s Staying in Touch events can help your patients stay connected and informed during this challenging time. Your patients can join us to hear about staying healthy, managing stress, being active, and connecting with their community—all from the comfort of home!

      •Hosted by experts on preventive medicine, mental health, and other topics.
      •Participants can stay for all or part of these 30- to 45-minute events.
      •Participants can join by phone or online.

For more information or to join an event, visit our Staying in Touch Events page.
3/2020Managing Withdrawal From Alcohol Addiction During the COVID-19 Crisis
Read our provider notice on managing withdrawal from alcohol addiction during the COVID-19 crisis.
3/2020What You Need to Know About Coronavirus
As COVID-19 makes headlines, UPMC Health Plan wants to update you, our network provider, on decisions we have made that will affect you and our members, your patients. UPMC Health Plan is actively monitoring this evolving situation and timely, appropriate care for our members remains our top priority. We are working closely with county, state, and national health agencies and organizations to ensure that we are able to share critical, accurate information that allows both you and our Provider Services team to be prepared for new developments.

Read about billing updates.

Read about telehealth services.

Read our Community Care Behavioral Health Telehealth Services update.
3/2020Phenytoin Oral Suspension USP, 125 mg/5 mL
Taro Pharmaceuticals U.S.A. Inc. is recalling these two lot numbers of Phenytoin Oral Suspension USP,125 mg/5 mL, NDC# 51672-4069-1: #327874 and #327876 (expiration date December 2020). This recall is for safety reasons. Phenytoin Oral Suspension is used to treat seizures. Read the full text of the withdrawal.
3/2020Market Withdrawal: Belviq and Belviq XR (Lorcaserin)
The U.S. Food and Drug Administration (FDA) has asked Eisai Inc.—which manufactures the weight loss drugs Belviq and Belviq XR (lorcaserin)—to withdraw the drugs from the U.S. market because of a safety clinical trial that showed an increased occurrence of cancer. Read the full text of the withdrawal.

2019 Announcements

9/2019Recall: Relpax 40 mg Tablets
Relpax is manufactured by Pfizer Inc. Two lot numbers of this medication have been recalled for safety reasons. This recall is due to the possible presence of bacteria. To date, Pfizer Inc. has not received any customer complaints or reports of adverse events related to this issue. Read the full text of the recall.
8/2019Recall: Drospirenone and Ethinyl Estradiol Tablets, USP
Jubilant Cadista Pharmaceuticals Inc. is recalling one lot of Drospirenone and Ethinyl Estradiol Tablets, USP, 3 mg/ 0.02mg due to concern that the medication will not work as well as it should. This is based on lab test results on how the medication is absorbed into the body. To date, Jubilant Cadista Pharmaceuticals Inc. has not received any reports of adverse events. Read the full text of the recall.
7/2019UPMC Health Plan would like to announce the new Hip and Knee Joint Replacement Centers of Excellence
UPMC Health Plan has established a Center of Excellence program for elective hip and knee joint replacement surgery to promote high-quality outcomes for members. The UPMC Health Plan Hip and Knee Joint Replacement Surgery Center of Excellence program recognizes surgical facilities and orthopedic surgeons that demonstrate high-quality outcomes, low complication rates, and the best patient experience for UPMC Health Plan members in need of joint replacement surgery. More information is available at upmchp.us/hip-knee-coe.
6/2019Recall: Losartan Potassium Tablets, USP
The FDA advises that patients who are on Losartan Potassium Tablets and Losartan Potassium/Hydrochlorothiazide combination tablets, USP should continue taking their medication and contact their pharmacist, physician, or medical provider for advice regarding an alternative treatment, as the risk of harm to the patient’s health may be higher if the treatment is stopped immediately without any alternative treatment. Read the full text of the recall.
6/2019Recall: Fentanyl
Heritage Pharmaceuticals Inc. is recalling lot #VEAC025 of Amikacin Sulfate Injection, USP, 1g/4 mL (250mg/mL) and lot #VPCA172 of Prochlorperazine Edisylate Injection, USP, 10mg/2mL (5mg/mL). This recall was issued because microbial growth was detected in unreleased medication. Read the full text of the recall.
6/2019Recall: Fentanyl
Alvogen Inc. is recalling two lots of Fentanyl Transdermal System 12 mcg/h transdermal patches because of mislabeling. A small number of cartons labeled 12 mcg/h Fentanyl Transdermal System patches contained 50 mcg/h patches. Read the full text of the recall.
5/2019EPSDT changes now in effect
Please note that changes have been made to the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Periodicity Schedule. These changes were made in response to the Department of Human Services (DHS) Medical Assistance Bulletins released on August 1, 2018, and are relevant to all Medical Assistance providers. View the updated EPSDT Periodicity Schedule and UPMC for You billing guide.
5/2019Recall: Losartan Potassium Tablets, USP
Based on the available information, the risk of developing cancer following long-term use of the product containing high levels of the impurity NMBA cannot be ruled out. The FDA advises that Consumers should contact their doctor for further guidance and potential change of treatment before they stop taking the product. Read the full text of the recall.
4/2019Recall: Valsartan and Amlodipine/Valsartan
Aurobindo Pharma USA Inc. is recalling 39 lots of Valsartan and Amlodipine/Valsartan tablets because of an impurity found in the product. The impurity—N-nitrosodiethylamine (NDEA)—is classified as a probable human carcinogen. Read the full text of the recall.
4/2019Recall: Losartan Potassium Tablets, USP
Legacy Pharmaceutical Packaging, LLC is recalling 3 repackaged lots of Losartan Potassium Tablets, USP, 50 mg. This recall was prompted due to Torrent Pharmaceuticals LTD issuing a voluntary nationwide recall of Losartan Tablets, USP, because of an impurity found in the product. Read the full text of the recall.
4/2019Recall: Losartan Potassium Tablets, USP
Legacy Pharmaceutical Packaging, LLC is recalling 40 repackaged lots of Losartan Potassium Tablets, USP, 25 mg, 50 mg, and 100 mg. This recall was prompted due to Camber Pharmaceuticals, Inc. issuing a voluntary nationwide recall of Losartan Tablets, USP, because of an impurity found in the product. Read the full text of the recall.
3/2019Recall: Losartan/Hydrochlorothiazide (Macleods)
Macleods Pharmaceuticals Limited is recalling one lot number of Losartan/Hydrochlorothiazide because of an impurity found in the product. The impurity—N-nitrosodiethylamine (NDEA)—is classified as a probable human carcinogen. Read the full text of the recall.
3/2019Recall: Irbesartan and Irbesartan/Hydrochlorothiazide
Prinston Pharmaceutical Inc., dba Solco Healthcare LLC, is recalling 1 lot of Irbesartan and 7 lots of Irbesartan/Hydrochlorothiazide because of an impurity found in the product. The impurity—N-nitrosodiethylamine (NDEA)—is classified as a probable human carcinogen. Read the full text of the recall.
3/2019Recall: Losartan and Losartan/HCTZ (Torrent)
Torrent Pharmaceuticals Limited is recalling 10 lot numbers of Losartan and 6 lot numbers of Losartan/Hydrochlorothiazide because of an impurity found in the product. The impurity—N-nitrosodiethylamine (NDEA)—is classified as a probable human carcinogen. Read the full text of the recall.
1/2019Recall: Valsartan
Aurobindo Pharma USA Inc. is recalling 80 lots of Valsartan, Amlodipine and Valsartan, and Valsartan and Hydrochlorothiazide because of an impurity found in the product. Read the full text of the recall.
1/2019Recall: Losartan (Torrent)
Torrent Pharmaceuticals Limited is recalling 10 lot numbers of Losartan because of an impurity found in the product. The impurity—N-nitrosodiethylamine (NDEA)—is classified as a probable human carcinogen. Read the full text of the recall.

2018 Announcements

12/2018Recall: Infant Ibuprofen
Tris Pharma Inc. is recalling three lots of Infants’ Ibuprofen Concentrated Oral Suspension, USP (NSAID) 50 mg per 1.25 mL. The recalled lots have been found to potentially contain higher concentrations of ibuprofen. No problems linked to this recall have been reported. Read the full text of the recall.
12/2018Recall: Sodium Chloride Injection .09%
Fresenius Kabi USA is recalling 163 lots of Sodium Chloride Injection 0.9% vials because of mislabeling. The product insert states that stoppers for both the 10 ml and 20 ml vials do not contain rubber latex. However, the product is being recalled because the stoppers have been found to contain natural rubber latex. Read the full text of the recall.
12/2018Recall: Losartan HCTZ
Mylan Pharmaceuticals is recalling select lot numbers of Valsartan, Amlodipine and Valsartan, and Valsartan and Hydrochlorothiazide because of an impurity found in the product. The impurity—N-nitrosodiethylamine (NDEA)—is classified as a probable human carcinogen. Read the full text of the recall.
11/2018Recall: Losartan HCTZ
Sandoz Inc. is recalling lot number JB8912 of Losartan Hydrochlorothiazide because of an impurity found in the drug product. No problems linked to this recall have been reported so far. Read the full text of the recall.
11/2018Recall: Ortho-Novum
Janssen Pharmaceuticals Inc. is recalling several lots of Ortho-Novum 7/7/7 and 1/35 tablets because the patient information provided inside affected packages does not include the appropriate instructions for the dispenser. The Ortho-Novum product itself remains safe and effective for use with the appropriate dispenser instructions. Read the full text of the recall.
11/2018Recall: Ibesartan
ScieGen Pharmaceuticals is voluntarily recalling all unexpired lots of Irbesartan because of an impurity found in the product. Companies affected by this recall include Golden State Medical Supply Inc. (GSMS) and Westminster Pharmaceuticals. Read the full text of the recall.
8/2018Recall: Valsartan and Valsartan/Hydrochlorothiazide (HCTZ)
Solco Healthcare, Teva Pharmaceuticals Industry Ltd., Major Pharmaceuticals, Camber Pharmaceuticals, Northwind Pharmaceuticals, and several repackaging manufacturers are voluntarily recalling all unexpired lots of Valsartan and Valsartan/Hydrochlorothiazide because of an impurity found in the product. Read the full text of the recall.
8/2018Recall: Levothyroxine or Liothyronine (Thyroid Tablets)
Westminster Pharmaceuticals, LLC is voluntarily recalling all unexpired lot numbers of Levothyroxine and Liothyronine (Thyroid Tablets, USP) 15 mg, 30 mg, 60 mg, 90 mg, and 120 mg. These products are being recalled as a precaution because they were manufactured using active pharmaceutical ingredients sourced prior to a 2017 inspection that found one supplier to have deficiencies with Current Good Manufacturing Practices (cGMP). Read the full text of the recall.
8/2018Recall: Valsartan and Valsartan/Hydrochlorothiazide
Solco Healthcare, Teva Pharmaceuticals Industry Ltd., and Major Pharmaceuticals are voluntarily recalling all unexpired lots of Valsartan and Valsartan/Hydrochlorothiazide because of an impurity found in the product. Read the full text of the recall.
6/2018Provider Manual Update
The UPMC for You (Medical Assistance) chapter of the UPMC Health Plan Provider Manual has been updated with an effective date of July 1, 2018. To view the most recent changes, visit our Provider Manual page.
6/2018Recall: Fluticasone Propionate Nasal Spray
Apotex Corp. is voluntarily recalling one lot of Fluticasone Propionate Nasal Spray due to containing small glass particles. Read the full text of the recall.
6/2018Recall: Naloxone Hydrochloride Injection
Hospira Inc. is voluntarily recalling two lots of Naloxone Hydrochloride Injection because of the potential presence of embedded and loose particulate matter on the syringe plunger. Read the full text of the recall.
5/2018Recall: Ampicillin and Sulbactam for Injection
AuroMedics Pharma LLC is voluntarily recalling two lots of Ampicillin and Sulbactam for Injection because customers noticed red particulate matter in the product. Read the full text of the recall.
3/2018Recall: Methylprednisolone Sodium Succinate for Injection
Sagent Pharmaceuticals Ltd. has initiated this voluntary recall of Methylprednisolone Sodium Succinate for Injection, USP to the user level due to the discovery of high out-of-specification impurity results. Read the full text of the recall.
3/2018 Alcohol Use and Alcohol Problems Event
We want to help you, help your patients. UPMC Health Plan is hosting an event to discuss and share resources that help your patients and their families cope with an alcohol problem. Learn more about the event.
2/2018 Reminder: Update PROMISe IDs
Effective January 1, 2018, UPMC for You Medicaid, UPMC for Kids CHIP, and UPMC for Life Dual Medicare SNP providers must have updated PROMISe ID numbers to render, order/refer, or prescribe items or services to patients covered under those plans. If you do not have a PROMISe ID, claims will be denied.
Don’t wait — enroll online now!
2/2018 Align yourself with thought leaders
Our leaders are applying their expertise, along with creativity and rigor, to some of the most challenging problems in health care delivery and financing. Our latest research findings can give you a unique perspective and new ideas on current topics.
To review the latest thought leadership lineup, please visit http://upmchp.us/research.
1/2018 Obstetrical Needs Assessment (OBNA) form submission
Please submit the obstetrical needs assessment form (OBNA) electronically via Optum OB Care or EPIC. Provider offices without capability for EPIC submission should use Optum OB Care. Faxed copies will not be accepted.
1/2018 Recall: Clopidogrel 75 mg tablets
International Laboratories, LLC is voluntarily recalling Lot# 117099A of Clopidogrel tablets, USP 75 mg, packaged in bottles of 30 tablets, to the consumer level due to mislabeling. The product is labeled as Clopidogrel tablets USP 75 mg but may contain Clopidogrel 75 mg or Simvastatin 10 mg. Read the full text of the recall.
1/2018 Obstetrical Needs Assessment (OBNA) form submission
Please submit the obstetrical needs assessment form (OBNA) electronically via Optum OB Care or EPIC. Provider offices without capability for EPIC submission should use Optum OB Care. Faxed copies will not be accepted.

2017 Announcements

9/2017 Recall: All liquid products manufactured by PharmaTechLLC
As a precautionary measure, the distribution firms Leader Brand, Major Pharmaceuticals, and Rugby Laboratories are jointly issuing a nationwide voluntary recall of all lots within expiry of all liquid products manufactured by PharmaTechLLC at its FDA registered facility in Davie, FL, due to possible product contamination. Read the full text of the recall.
9/2017 Recall: Vancomycin Hydrochloride for Injection, USP, 750 mg/vial
Vancomycin Hydrochloride for Injection is manufactured by Hospira. The company recalled one lot number of the medication for safety reasons. This recall is because of the presence of particulate matter. Read the full text of the recall.
9/2017 Recall: Lorazepam Oral Concentrate, USP 2 mg/ml
Lorazepam Oral Concentrate, USP 2mg/ml is being recalled for safety reasons. The dropper may have dose markings in reverse number order, no dose markings, or dose markings that are shifted. Read the full text of the recall.
9/2017 Recall: Pravastatin 40 mg tablet
Pravastatin 40 mg tablets are being recalled for safety reasons. The product may also be labeled as Pravastatin SodiumTablets USP 40 mg but contains Bupropion Hydrochloride XL 300 mg tablets. Read the full text of the recall.
8/2017 Prescription Drug Misuse and Addiction Resources
Like you, we’re here for our community. UPMC Health Plan is hosting an event to discuss and share resources that help your patients and their families cope with a prescription drug problem. Stay educated about the prescription drug epidemic. Learn more about the event.
6/2017 Recall: Eliquis (apixaban) 5 mg tablet
Eliquis (apixaban) 5 mg tablets are being recalled as a precautionary measure from a customer complaint that a bottle labeled as Eliquis 5 mg was found to contain Eliquis 2.5 mg tablets. Read the full text of the recall.
6/2017 Recall: Mibelas 24 Fe Chewable Tablets
Mibelas 24 Fe Chewable Tablets are being recalled for safety reasons because these tablets may be out of sequence and missing expiry/lot information. Read the full text of the recall.
4/2017 Recall: EpiPen and EpiPen Jr Auto-Injectors (epinephrine injection)
EpiPen® and EpiPen® Jr Auto-Injectors are being recalled for safety reasons because these devices may contain a defective part that may result in the devices’ failure to activate. Read the full text of the recall with a list of lot numbers.