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

Voluntary nationwide recall: True Metrix (Trividia – May)

Trividia Health is recalling all True Metrix Blood Glucose Systems for an issue with the software design of the E-5 Error Code and instructions for the user in the “Messages” section of the Owner’s Booklet/System instructions for use and online labeling and help guides.
May 2026Pharmacy Updates

Community Care Behavioral Health is excited to announce this free upcoming web-based training opportunity:

A growing body of U.S. and international research demonstrates that the rapid legalization and commercialization of gambling—including online casinos and mobile sports betting platforms—are associated with significant and escalating gambling related harm. Although Pennsylvania specific prevalence data remain limited, available evidence is increasingly concerning, with gambling disorder linked to alarmingly high rates of suicide, psychiatric comorbidity, and social and financial harm. Drawing on lessons from the tobacco and opioid crises, this presentation will examine how delayed recognition and regulation can amplify population level harm, underscoring the need for earlier screening, prevention, and policy engagement. Participants will gain practical guidance on identifying patients at elevated risk, implementing evidence informed screening and diagnostic strategies, and applying current treatment approaches across the lifespan.
May 2026Education/Webinars

Bridging Smiles and Systems: Collaborative Care for Children with Chronic Conditions

Please join us for a live, CME-accredited and CEU-accredited webinar on May 13 from noon to 1p.m., that will explore the critical connection between oral health and pediatric chronic conditions such as diabetes, asthma, congenital heart disease, and ADHD.
Apr. 2026Education/Webinars