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

Important announcement – Telehealth submissions

As of October 1, 2025, UPMC Health Plan continues to accept the submission of telehealth claims. Providers may conduct telehealth visits for UPMC Health Plan members in all UPMC Insurance products. UPMC Insurance products include UPMC Advantage group and individual products, UPMC for Life Medicare Advantage plans, UPMC for Kids CHIP plans, UPMC Community HealthChoices, and UPMC for You Medical Assistance plans.
Sep. 2025Important Notices

October 2025 UPMC for You and UPMC Community HealthChoices Formulary Update

Effective October 1st, 2025, Xifaxan and Retin-A (cream, gel) will no longer be covered by UPMC for You and UPMC Community HealthChoices due to non-participation in the Medicaid Drug Rebate Program.
Sep. 2025Pharmacy Updates

Biosimilar Medication Formulary Updates

Updates to formulary biosimilar medications for denosumab, eculizumab, and ustekinumab products
Sep. 2025Pharmacy Updates