ACA Risk Adjustment Claims Submission Announcement

Feb. 2025Important Notices
Notice: Submit your claims for ACA members 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. The U.S. Department of Health & Human Services requires all issuers to submit their calendar year claims to the EDGE server by April 30 every year in order to provide more complete and an accurate picture of each patient’s health status. Any claims adjudicated after the deadline are not included for EDGE data submission. You can submit claims through Provider OnLine at upmchealthplan.com/providers/medical. If you have any questions, please reach out to Provider Services or your physician account executive.

Recent Announcements

PA DOH Antibiotic Stewardship Resources

Order antibiotic stewardship resources at no cost
Jun. 2026Important Notices

Medical device correction: Omnipod (Insulet – May 2026)

Insulet Corporation Inc. has announced a medical device correction for certain Omnipod Pods. These pods are wearable devices that are used to deliver insulin.
Jun. 2026Pharmacy Updates

Clinical documentation required for medical policy prior authorizations

As you know, UPMC Health Plan requires certain clinical documentation/notes in support of a request for prior authorization for the listed procedures below 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.
Jun. 2026Important Notices