Updates to Utilization Management (UM) phone line hours
Apr. 2024Important Notices
Effective Sunday, May 5, 2024, the UPMC Health Plan UM department staff and UM phone lines will no longer be available on Sundays. The UM department will be operating during the business days of Monday through Saturday from 8 a.m. to 4:30 p.m.
UPMC Health Plan’s secure websitel, Provider OnLine, will remain open for all level of care authorizations and notifications.
UM cases will be processed per line of business and level of care timeliness requirements, as outlined in UPMC Health Plan's Provider Handbook and Policies.
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 productsSep. 2025Pharmacy Updates