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
Register for the Oral Health in Your Pediatric Office CME - accredited webinar
Please join us for a live, CME-accredited webinar on Wednesday, March 11 from noon to 1 p.m. that will provide an overview of oral health in your pediatric office. Providers with a(n) MD/DO, PA, CRNP, RN, or LPN may also apply for topical fluoride certification after completion of this course.Jan. 2026Education/Webinars
CME Webinar: Compassionate Care for the Fasting Patient During Ramadan
Please join us for a live, CME-accredited webinar on Tuesday, Feb. 3, that will educate clinicians on providing compassionate and culturally sensitive care to fasting patients during Ramadan.Jan. 2026Education/Webinars
Medicaid provider update: High-cost Medicaid drug billing
Billing requirements for Medicaid-covered drugsDec. 2025Important Notices