Documents & Resources for Members

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Please call the UPMC Community HealthChoices Health Care Concierge Team at 1-844-833-0523 (TTY: 711) to request any of these documents in hard copy or alternative format.

    Translated Documents

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    Prior Authorization Metrics for Medical Items and Services (Excluding Drugs)

    To comply with the CMS Interoperability and Prior Authorization final rule, UPMC Community HealthChoices is required to annually report aggregated prior authorization metrics on our website. This includes a list of all medical items and services (excluding drugs) that require prior authorization, as well as data on prior authorization requests for those items and services (approvals, denials, etc.) during the previous calendar year. Publicly reporting these metrics promotes transparency and accountability, helps patients understand prior authorization processes, and enables providers to evaluate payer performance. In addition, metrics can be used to compare plans, programs, and payers. If you have questions about the data below, please contact Member Services.

    These are the medical items and services for which we require prior authorization (excluding drugs)

    Beginning Jan. 1, 2026, the CMS Interoperability and Prior Authorization final rule requires UPMC Commuity HealthChoices to send prior authorization decisions within:

    • 72 hours for expedited requests (urgent)
    • 7 calendar days for standard requests (nonurgent).

    Standard/Expedited Quantities/Review Time data

     

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