Update to Multiple Procedure Payment Reduction reimbursement

Oct. 2024Important Notices

We previously communicated to both contracted physicians and facilities that UPMC Health Plan will begin applying Multiple Procedure Payment Reduction (MPPR) on certain diagnostic imaging services for Commercial, Medicare and Medicaid lines of business, with contracts based on a percentage of Medicare APC or % billed charges excluded.

There are modifications to this change, as only professional claims will be affected. This implementation will not affect facility claims. Additionally, this application will not include Medicaid line of business claims as previously noted. If you have any questions, please contact your physician account executive or call Provider Services at 1-866-918-1595.


Recent Announcements

Voluntary nationwide recall: Ocaliva (Intercept – September)

Intercept Pharmaceuticals, Inc. is voluntarily withdrawing Ocaliva® (obeticholic acid) from the market. Ocaliva is used to treat a rare liver disease called primary biliary cholangitis (PBC).
Oct. 2025Pharmacy Updates

HelpScript service helps patients enroll in manufacturer copay assistance programs

End-to-end provider support helps ensure a smooth submission process
Oct. 2025Important Notices

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