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

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