ACA Risk Adjustment Claims Submission Announcement

Jan. 2026Important Notices

Notice: Submit your claims for ACA members

This is a reminder that all network providers must submit outstanding calendar year (CY) 2025 claims for ACA members (Platinum, Gold, Silver, and Bronze plans) no later than April 1, 2026. The U.S. Department of Health and Human Services requires issuers to submit their CY claims to the EDGE server by April 30 every year to provide a complete and accurate picture of each patient’s health status.

Claims adjudicated after the deadline will not be included for EDGE data submission.

You can submit claims through Provider OnLine at upmchealthplan.com/providers/medical. If you have any questions about this matter, please contact Provider Services or your physician account executive.

Recent Announcements

Virtual Institute: Bridging the Gap: Foundations of Integrated Care CME Courses Available

Bridging the Gap: Foundations of Integrated Healthcare is a free educational series designed to support behavioral health and physical health providers in integrating physical health and wellness strategies into their practices and programs to support recovery of individuals living with serious mental illnesses. The series emphasizes tools, education, and resources that empower healthcare providers and individuals to become informed and effective managers of their health and health care.
Jun. 2026Education/Webinars

Important information regarding Medicare GLP-1 Bridge through CMS

The Centers for Medicare & Medicaid Services (CMS) is expanding access to certain GLP-1 medications through the Medicare GLP-1 Bridge short-term demonstration starting July 1, 2026.
Jun. 2026Important Notices

CME/CEU Webinar: Bright Beginnings: The Role of Medical and Dental Providers in Early Oral Health

Please join us for a live, CME-accredited and CEU-accredited webinar on Monday, Aug. 24 from noon to 1 p.m., that will educate providers on the importance of early childhood oral health.
Jun. 2026Education/Webinars