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
Certified Community Health Worker (CCHW) Provider Billing Notification
UPMC for You will now reimburse for up to three certified community health worker (CCHW) visits per member per calendar year for Medicaid recipients, per the Pennsylvania Department of Human Services (PA DHS).Apr. 2026Important Notices
CME Webinar: First Annual Dr. Jim Withers Lecture
Please join us for the First Annual Dr. Jim Withers Lecture, featuring Dr. Jim Withers, a global leader in compassionate, justice-centered careApr. 2026Education/Webinars
Provider Directory Updates and Required Attestation
As you know, UPMC Health Plan requires all providers to verify their provider directory information at least every 90 days (quarterly).Apr. 2026Important Notices
