Recent Announcements
Medical device correction: FreeStyle Libre 3 (Abbott – December)
Abbott has announced a medical device correction for certain FreeStyle Libre 3 sensors. These sensors monitor blood glucose levels as part of the FreeStyle Libre system, which includes a sensor, reader, and app. The correction applies only to the sensor. No other Libre products or Abbott biowearables are affected.Dec. 2025Pharmacy Updates
CME Webinar: The State of Telehealth in 2026
Please join us for a live, CME-accredited webinar on Tuesday, Jan. 27, from noon to 1 p.m. that will share updates on the state of telehealth for 2026.Dec. 2025Education/Webinars
Voluntary nationwide recall: Atorvastatin (Alkem – October)
Ascend Laboratories LLC is recalling multiple lots of Atorvastatin Calcium Tablets USP. Atorvastatin is used for the treatment of high cholesterol and to reduce the risk of certain cardiovascular events, such as heart attack and stroke.Nov. 2025Pharmacy Updates
Understanding available resources for substance misuse and addiction
Information available on the internet can be overwhelming when searching on the topic of substance misuse and addiction. UPMC Health Plan has a dedicated webpage containing information and links to treatment service options, harm reduction services, and other supports. The webpage includes local, state, and national resources to help streamline the search process for members and their families who may be experiencing challenges related to substance misuse and addiction, and for providers who may be looking for information on how to best support their patients. Aug. 2025Important Notices
Important announcement: UPMC Health Plan retires MP.PA.147
This communication is in regards to UPMC Health Plan Policy MP.PA.147 – Diagnostic and Surveillance Colonoscopy, 18 Years Old and Older. UPMC Health Plan previously communicated that the prior authorization requirement under this policy would be paused until Sept. 1, 2025. However, policy MP.PA.147 has been retired, and this policy will no longer be implemented or active. Aug. 2025Important Notices
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
Feedback sought on your experience with UPMC Health Plan
You may be invited to participate in a 2025 Press Ganey provider satisfaction survey, which will begin next month. This survey will be given to a random sampling of in-network primary care providers. Jul. 2025Important Notices
Important Notice Regarding Prior Authorizations for MP.PA.147
UPMC Health Plan previously communicated that prior authorizations would be required under policy Diagnostic and Surveillance Colonoscopy, 18 Years Old and Older – MP.PA.147 effective June 1, 2025. However, the prior authorization requirement will be paused until Sept. 1, 2025. Jul. 2025Important Notices
Clinical documentation required for hip, knee, and shoulder prior authorizations
As you know, UPMC Health Plan requires certain clinical documentation/notes in support of a request for prior authorization for hip, knee, and shoulder procedures in accordance with its established policies and procedures, in addition to CMS requirements that medical record documentation must support the medical necessity of the services requested.Jul. 2025Important Notices
Understanding MP.PA.147
Understanding changes to the Diagnostic and Surveillance Colonoscopy, 18 Years Old and Older – MP.PA.147 policy Jul. 2025Important Notices
Register for the Oral Health in Your Pediatric Office CME -accredited webinar
Please join us for a live, CME-accredited webinar on Wednesday, Sept. 10 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. Jun. 2025Education/Webinars
UPMC for Kids now provides statewide CHIP coverage
Effective July 1, 2025, comprehensive high-quality health insurance coverage is available to even more children and teens throughout the state. UPMC for Kids, UPMC Health Plan’s Children’s Health Insurance Program (CHIP) plan, has expanded into three additional counties across Pennsylvania to include Montour, Northumberland, and Pike. Jun. 2025Education/Webinars
Pause in Prior Authorization Policies
On April 1, 2025, we announced that UPMC Health Plan would start requiring prior authorization for certain services. Please note that we are delaying or changing the implementation of prior authorization for some of these services, as described below.May 2025Important Notices
May is Mental Health Awareness Month
“Turn Awareness into Action”Mental Health America founded Mental Health Month in 1949, and since that time, every May has been a time to unite millions of people to promote awareness, provide vital resources, and advocate for everyones mental well-being. 1 in 5 people will experience a mental health condition in any given year¹. Mental health affects us all, and its critical that we move beyond awareness to take meaningful steps for our well-being and that of our community. May 2025Important Notices
Special notice: Important policy changes
Effective June 1, 2025, UPMC Health Plan will be implementing policy changes that will require providers to obtain prior authorizations for services listed in the following policies. For more information, please visit upmchp.us/policiesandprocedures. May 2025Important Notices
Provider OnLine Enhancements
Provider OnLine will be launching enhancements to the authorization process on April 18, 2025. The enhancement will include the following updates:Apr. 2025Important Notices
HPV Vaccination Resources
To help protect against cancers later in life, it is important to increase HPV vaccination rates in adolescents starting at age 9. According to the Centers for Disease Control and Prevention, HPV vaccination is routinely recommended at age 11 or 12, but the vaccine can be given starting at age 9.1 The Pennsylvania Cancer Coalition cites the following potential benefits of initiating the HPV vaccine series at age 9:2Mar. 2025Important Notices
Special notice: Important policy changes
Effective May 1, 2025, the following policies will be retired and replaced with prior authorization policies. For more information, please visit upmchp.us/policiesandprocedures.Mar. 2025Important Notices
2025 Preventative Care Rewards Program
We’re excited to continue our preventive care rewards program in 2025. This program allows eligible UPMC for Life patients to earn rewards when they complete certain preventive services, such as an annual wellness visit, a breast cancer screening, a colorectal cancer screening, or a diabetic retinal eye exam (for members with diabetes only). Feb. 2025What's New
Important updates on influenza prevention and treatment
As we continue to navigate flu season, we want to emphasize three critical areas to ensure the health and safety of your patients who are UPMC Health Plan members: Consider antiviral therapy when appropriate, encourage masking to prevent the spread of respiratory viruses, and continue to recommend the flu vaccine.Feb. 2025Important Notices
HIPAA Fax Line Permanently Closed as of 2/1/2025
The UPMC Health Plan HIPAA Fax Line 412-454-7829 has been permanently closed and is no longer receiving faxes. The most efficient way to submit a PRD (Personal Representative Designation) form is for the member to do so via the Member Site (Digital Account). Feb. 2025Important Notices
ACA Risk Adjustment Claims Submission Announcement
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. Feb. 2025Important Notices
Voluntary nationwide recall: Systane (Alcon – December)
Alcon Laboratories is recalling one lot, lot 10101, of Systane Lubricant Eye Drops Ultra PF, Single Vials On-the-Go. Systane Lubricant Eye Drops. Ultra PF is used for the temporary relief of burning and irritation in persons with dry eye symptoms.Jan. 2025Pharmacy Updates
UPMC Health Plan medical drug coverage updates
UPMC Health Plan initiated changes to certain medical drug coverage policies for all lines of business on Jan. 1, 2025. Please visit upmchp.us/pharm-services-medical for more information. If you have questions about the changes, call Provider Services at 1-866-918-1595. Thank you for your continued support and for the great care you provide our members.
Jan. 2025Important Notices
