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
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