Member eligibility and benefits information transitioning from NaviNet to Provider OnLine

Dec. 2024Important Notices
Effective March 20, 2025, UPMC Health Plan network providers will no longer have access to member eligibility and benefits information through NaviNet. After this date, network providers should visit upmchealthplan.com/providers/medical/ to access this information. If you have questions or issues accessing Provider OnLine, please contact your physician account executive or network manager or call Provider Services 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