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
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