Medicaid implementation/Member enrollment reminder

Sep. 2022Important Notices
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.

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