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: Sucralfate (Nostrum – July)

Nostrum Laboratories, Inc. is recalling all lots of Sucralfate Tablets USP 1 gram. Sucralfate is used for the prevention and treatment of certain stomach ulcers.
Jul. 2025Pharmacy Updates

Receive consultations to better support the behavioral health needs of child and adolescent patients

The Telephonic Psychiatric Consultation Service Program (TiPS) is a Pennsylvania HealthChoices program that gives primary care providers access to free, on-demand consultations with child and adolescent psychiatrists, typically within 30 minutes. It is available to providers of children and adolescents who have Pennsylvania Medicaid, Children’s Health Insurance Program, or UPMC Health Plan commercial insurance.
Jul. 2025What's New

Voluntary nationwide recall: Sucralfate (Nostrum – July)

Nostrum Laboratories, Inc. is recalling all lots of Sucralfate Tablets USP 1 gram. Sucralfate is used for the prevention and treatment of certain stomach ulcers.
Jul. 2025Pharmacy Updates