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
Voluntary nationwide recall: Alcohol Pads (Cardinal – March)
Cardinal Health is recalling multiple lots of Webcol™ Large Alcohol Prep Pads (70% isopropyl alcohol). Alcohol prep pads are used for external cleansing of the skin.Mar. 2026Pharmacy Updates
Medical device correction: Omnipod 5 (Insulet – March 2026)
Insulet Corporation has announced a medical device correction for certain Omnipod 5 pods. These pods are wearable devices that are used to deliver insulin.Mar. 2026Pharmacy Updates
Asymptomatic Severe Coronary Disease: Detection to Decisions. Do We Know The Proper Management?
In this new CME course, Krishna V. Tummalapalli, MD, interventional cardiologist, UPMC Heart and Vascular Institute, discusses how to explain the importance of early detection of coronary artery disease, as well as how to describe how early identification can reduce future cardiovascular events and identify appropriate first line medical therapy strategies for patients with asymptomatic stable ischemic heart disease.Mar. 2026Education/Webinars
