ACA Risk Adjustment Claims Submission Announcement

Feb. 2025Important Notices
Notice: Submit your claims for ACA members UPMC Health Plan would like to remind all network providers to submit all outstanding CY 2024 claims for ACA members (Platinum, Gold, Silver, and Bronze plans), no later than April 1, 2025. The U.S. Department of Health & Human Services requires all issuers to submit their calendar year claims to the EDGE server by April 30 every year in order to provide more complete and an accurate picture of each patient’s health status. Any claims adjudicated after the deadline are not included for EDGE data submission. You can submit claims through Provider OnLine at upmchealthplan.com/providers/medical. If you have any questions, please reach out to Provider Services or your physician account executive.

Recent Announcements

CME Webinar Series: Introducing Physicians and their teams to Value-Based Health Care

Please join us for a new CME-accredited webinar series on value-based care. This series is designed to introduce practicing physicians and their teams to value-based health care. Over the course of six sessions, we will define the components of value and identify the tools necessary to deliver high-value care for a population.
Feb. 2026Education/Webinars

Bridging Smiles and Systems: Collaborative Care for Children with Chronic Conditions

Please join us for a live, CME-accredited and CEU-accredited webinar on May 13 from noon to 1p.m., that will explore the critical connection between oral health and pediatric chronic conditions such as diabetes, asthma, congenital heart disease, and ADHD.
Feb. 2026Education/Webinars

February 2026 UPMC for You and UPMC Community HealthChoices formulary update

Pulmicort Flexhaler has a new distributor, Rubicon Holding. National Drug Codes (NDCs) for Pulmicort Flexhaler from Rubicon Holding are not included in the Medicaid Drug Rebate program and are not covered under the Medicaid Prescription Drug Program. Pulmicort Flexhaler NDCs from the previous manufacturer, H2 Pharma, have been discontinued but may be billed/dispensed until supplies are exhausted.
Feb. 2026Pharmacy Updates