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

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.
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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.
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Provider OnLine Multi-Factor Authentication Enhancements coming soon

Microsoft changes and security enhancements will soon require Provider OnLine users to complete multi-factor authentication (MFA) each time they log in to access the portal. MFA is a security feature that adds an extra layer of protection by requiring more than just a password. This MFA requirement is expected to take effect on June 25, 2026.
Jun. 2026Important Notices