New requirements for physician extenders
Feb. 2022Important Notices
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.
Recent Announcements
The importance of PRD forms for complex patients and staying updated on changes
Personal representative designation (PRD) forms are critical to the care process for patients and providers alike. Not only do PRDs support accurate, efficient, and compliant patient care—they also streamline administrative processes.Aug. 2025Important Notices
Important announcement: UPMC Health Plan retires MP.PA.147
This communication is in regards to UPMC Health Plan Policy MP.PA.147 – Diagnostic and Surveillance Colonoscopy, 18 Years Old and Older. UPMC Health Plan previously communicated that the prior authorization requirement under this policy would be paused until Sept. 1, 2025. However, policy MP.PA.147 has been retired, and this policy will no longer be implemented or active.Aug. 2025Important Notices
CMS expands Medicare Advantage RADV audits to all eligible plans
On May 21, 2025, the Centers for Medicare & Medicaid Services (CMS) announced a substantial expansion of its Risk Adjustment Data Validation (RADV) audit program for Medicare Advantage plans.Aug. 2025What's New