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Announcements

10/2021COVID-19 vaccine updates
Pfizer-BioNTech COVID-19 Vaccine Booster Shot
On Sept. 22, 2021, the U.S. Food and Drug Administration (FDA) amended the emergency use authorization for the Pfizer-BioNTech COVID-19 Vaccine to allow for use of a single booster dose, to be administered at least six months after completion of the primary series. The CDC recommends COVID-19 Vaccine booster shots for the following Pfizer-BioNTech vaccine recipients who completed their initial series at least six months ago:

  • People 65 years and older and residents in long-term care settings should receive a booster shot of Pfizer-BioNTech’s COVID-19 vaccine at least 6 months after their Pfizer-BioNTech primary series,
  • People aged 50–64 years with underlying medical conditions should receive a booster shot of Pfizer-BioNTech’s COVID-19 vaccine at least 6 months after their Pfizer-BioNTech primary series,
  • People aged 18–49 years with underlying medical conditions may receive a booster shot of Pfizer-BioNTech’s COVID-19 vaccine at least 6 months after their Pfizer-BioNTech primary series, based on their individual benefits and risks, and
  • People aged 18-64 years who are at increased risk for COVID-19 exposure and transmission because of occupational or institutional setting may receive a booster shot of Pfizer-BioNTech’s COVID-19 vaccine at least 6 months after their Pfizer-BioNTech primary series, based on their individual benefits and risks.
Third Dose of Moderna and Pfizer-BioNTech for Immunocompromised
The FDA had previously authorized an additional vaccine dose of Pfizer or Moderna for people with weakened immune systems. Immunocompromised patients are eligible to receive a third dose of the Moderna or Pfizer vaccines at least 28 days after the second dose. UPMC offers online scheduling for the COVID-19 vaccines; UPMC Health Plan members can also schedule by calling a Health Care Concierge at 1-833-280-8510 (TTY: 711) Monday through Friday from 7 a.m. to 7 p.m. and Saturday and Sunday from 8 a.m. to 5 p.m.

For the most recent COVID-19 policy and billing updates from UPMC Health Plan, please see these resources:

9/2021CDC warns against off-label use for COVID-19 vaccines
The Centers for Disease Control and Prevention (CDC) guidelines are clear: Off-label use, including through booster shots or administration to patients outside of currently authorized age group(s), is NOT currently authorized for COVID-19 vaccines.1

Administration of the off-label product may not be covered under the PREP Act or the PREP Act declaration, and such use could come with consequences for providers and patients:

  • Providers may not have immunity from claims.
  • Individuals who receive a third dose may not be eligible for compensation after a possible adverse event.

Off-label use is in violation of the CDC COVID-19 Vaccination Program provider agreement, therefore it:

  • May not be reimbursable (administration fees for off-label doses may not be reimbursed by payers).
  • May impact a provider’s ability to remain in the CDC Program.
  • Could put a provider at risk of other potential sanctions.

To learn more, visit the CDC's COVID-19 Vaccine FAQ for health care professionals.

Source
1Centers for Disease Control and Prevention. COVID-19 Vaccine FAQs for Healthcare Professionals. Last reviewed: August 26, 2021. Accessed Sept. 8, 2021. https://www.cdc.gov/vaccines/covid-19/hcp/faq.html#off-label-use
10/2021Resolve claim denials without filing an appeal
You can quickly address questions on claim reconsiderations—often in the same day—in two easy ways:
  • Call Provider Services at 1-866-918-1595.
  • Send your question through Provider OnLine.

Using either of these avenues instead of filing an official appeal eliminates the up to 60-day response time and saves the resources and costs associated with an appeal.

If you feel a claim was denied in error (other than for medical necessity), please contact Provider Services and let us try to help you resolve your issue.
10/2021Philadelphia providers can enroll their sites for COVID-19 vaccine distribution
The Philadelphia Immunization Program is working with the Centers for Disease Control (CDC) to ensure COVID-19 vaccine is accessible to anyone in the city of Philadelphia who wishes to be vaccinated.

Providers can download the COVID-19 Enrollment Guide for step-by-step directions on how to enroll their site for COVID-19 vaccine distribution. To learn more, visit the program's COVID-19 website or email vaccines@phila.gov.
10/2021New PT authorization policy webinars
Attend one of our webinars to prepare for the implementation of the new authorization policy, Physical Therapy Services – MP.PA.129, effective Nov. 1, 2021. Any staff members who are involved in authorization requests should attend. Dates are available in October and November. Register and view additional information at upmchp.us/ptauthorizationpolicy.
10/2021UPMC Total Care – IBD support services offers access to behavioral health and nutrition services
UPMC Total Care–IBD clinical program is a comprehensive IBD program for UPMC Health Plan members that has proven results decreasing the use of inpatient and emergency department services for IBD patients. To learn more about this program and how clinicians can use it to help UPMC Health Plan members, read the article in October's Provider Partner Update.
10/2021Reinstatement of UPMC for Kids copayments for non-COVID-19 related services
Effective Oct. 1, 2021, copayments are being reinstated for all non-COVID-19 related services for UPMC for Kids members. We will continue to waive copayments for members for in-network COVID-19 diagnosis and treatment; however, low-cost and full-cost UPMC for Kids CHIP members will have copayments for non-COVID-19 related services such as sick visits to the PCP, specialist visits, urgent care, and emergency care.
10/2021Novillus measure: Childhood Immunization Status
We are excited to announce the launch of the Childhood Immunization Status (CIS) measure. This measure was initially deployed as display-only, but is now actionable. UPMC Health Plan has been working diligently in conjunction with Novillus to provide an enhanced user experience that will allow multiple uploads at different times, or submission of a group of vaccinations at one time. It will also present claims history, which will allow users to see current vaccinations that are already compliant or noncompliant. The new display will show two statuses, the first regarding compliance with the NCQA measure guidelines. This will be displayed under “CGMA Submission Status” as approved or rejected once reviewed by the Health Plan Nurse Review team. The second status will be under “14-day Complaint,” which refers to the NCQA 14-day rule. This will display as a green check or red X after processing through our HEDIS rules engine. We appreciate your patience as we work to provide the best user experience for this measure. For more information, select the Frequently Asked Questions menu item in the CGMA by clicking on the question mark icon in the upper right corner.

If you have questions about the Novillus CGMA, email UPMCCGMASupport@upmc.edu.
9/2021Lab Benefit Manager update
Based on provider feedback regarding implementation of the Lab Benefit Manager (LBM), UPMC Health Plan is moving the implementation date for the Lab Benefit Manager to Jan. 1, 2022, from the previous date of Oct. 1, 2021. The effective date of the LBM policies and procedures (MP.A001 through MP.A074) will be changed to 1/1/22; they will remain available for providers to view on the UPMC Health Plan Policies and Procedures webpage. All current UPMC Health Plan Policies and Procedures applicable to laboratory services will remain in effect through Dec. 31, 2021. The LBM webinar schedule will be updated to provide additional webinars closer to the implementation date. In addition, provider account executives will continue to outreach to providers for education. The LBM Claims Advice Tool will remain active on Provider OnLine to give providers the ability to review claims that will be subject to the LBM policies and procedures effective 1/1/22. The change in implementation date will allow additional time for provider education, addressing provider questions, and allowing providers to familiarize themselves with the LBM policies and LBM Claims Advice Tool in preparation for the 1/1/22 implementation date.
9/2021New CGMS capability for Childhood Immunization Status measure
Starting Monday, Oct. 4, a new CGMA capability will be available. Users will be able to upload medical record documentation to close the Childhood Immunization Status (CIS) measure. Once this feature is available, users will see a new status in the CGMA called “Manage.” Clicking on Manage will take users to a new page where claims and CGMA submissions can be viewed, and new medical record documentation can be uploaded. For more information, you can select the Frequently Asked Questions menu item in the CGMA by clicking on the question mark icon in the upper right corner of the screen.
9/2021Recall: Firvanq
Wilmington, MA, Azurity Pharmaceuticals Inc. (“Azurity”) is recalling one lot of Firvanq® (vancomycin hydrochloride for oral solution), Vancomycin 50 mg/mL Kit (“Firvanq®”) due to safety reasons. Firvanq is an antibiotic medication used to treat diarrhea caused by Clostridium difficile and enterocolitis (inflammation of the intestine caused by the bacterium Staphylococcus aureus). Read the full text of the Firvanq recall.
9/2021Recall: Lidocaine (Teligent)
Teligent is recalling one lot of Lidocaine Hydrochloride Topical Solution 4% (40 mg/mL), due to the lot being super-potent (higher than normal or acceptable potency). Lidocaine is a topical treatment used for pain relief. Read the full text of the Lidocaine (Teligent) recall.
9/2021E&M Documentation for Diagnosis Reporting
Join UPMC Health Plan's HCC Risk Adjustment Department's Marlana Tice, Program Director and Brenda Stevenson, Lead Physician Educator for a live CME-accredited* webinar on E&M Documentation for Diagnosis Reporting on Sept. 29, from noon to 1 p.m. Register for the webinar on E&M Documentation for Diagnosis Reporting today!

Providers can earn continuing medical education (CME) credits, and coders can earn 1.0 continuing education units (CEU) for attending this event.

*Provider is responsible for verifying CME eligibility.
9/2021Q3 Provider Directory Updates Required
We are reminding all providers that in order to comply with CMS/DHS/PID directives to maintain accurate directories. UPMC Health Plan Requires all providers to verify their Provider Directory information at least quarterly. It is critical for our members. The potential earnings through the Quality Partners Primary Care Incentive Program for CM and MC/SNP will only be available if directory information is verified quarterly.

UPMC Health Plan has contracted with Lexis Nexis to outreach via email & Online Portal, fax or phone to verify your provider information each quarter.

As the new quarter begins, you will be contacted by Lexis Nexis in the coming weeks ahead. We ask that you respond to this outreach and complete the attestation through the Lexis Nexis Portal as soon as practical. We ask that if possible, you respond within one to two weeks of being contacted.

Alternatively, please visit the Provider Directory and check that your provider information and office details are up to date and accurate. Please update it if needed.

Specifically, here is the information that must be reviewed/updated:

  • Ability to accept new patients
  • Street address
  • Phone number
  • Office hours
  • Hospital privileges
  • Any other information that affects your patient availability

You can view your information by searching the online directory for your name. Make updates to your information with the Change Provider Profile Info Form.

*If you have any questions on this matter or have trouble with your updates, please contact your physician account executive or contact Provider Directory Mgmt at ProviderDirectory@upmc.edu or by phone at 412-667-7876.

Thank you for your support in this ongoing effort!

*LexisNexis cannot change your current product participation, or the services contracted by your practice. For questions or concerns regarding product participation or contracted services, please contact your physician account executive.
9/2021Recall: Atovaquone
KVK Tech Inc. is recalling two lots of Atovaquone Oral Suspension due to complaints of unusual grittiness in the product, which is most likely due to exposure to extremely cold weather during shipment. Read the full text of the Atovaquone Oral Suspension recall.
8/2021Suicide prevention webinar now available
September is National Suicide Prevention Awareness Month—a time to reflect on the provider’s important role in this aspect of saving lives. Dr. Geoffrey Neimark and Lauren Marshall, MPW, present a non-CME educational offering that reviews information around suicide including epidemiology, risk and protective factors, and methods for screening and treatment. Sign in and watch the suicide prevention webinar now.
8/2021CGMA system update
An issue was discovered with processing negative eye exam claims for compliance in the Partners Program Gaps in Care (CGMA) system. UPMC Health Plan has received all eye exam claims submitted with a negative result this year through the system, and we are prioritizing the database fix to accurately close the gap. Users will see their appropriate status in the CGMA application after the system refresh in October.

We apologize for the inconvenience and appreciate your patience.
8/2021New lab benefit management program begins Oct. 1
On Oct. 1, UPMC Health Plan will implement a benefit management program to aid in the administrative application of medical policies for our laboratory claims.

If you provide laboratory services or refer patients to laboratories, please be aware that under this program, new medical policies and guidelines will affect payment for certain services, tests, and procedures. This will be true for all lines of business.

8/2021New policy MP.177 effective Oct. 1
Effective Oct. 1, 2021, UPMC Health Plan will implement a new policy: MP.177 Low-Value Services. MP.177 defines the criteria and indications for “low-value” services. UPMC Health Plan is committed to reducing unnecessary costs in the health care system that are the result of duplicative or medically unnecessary services.

“Low-value” care includes tests and procedures that should not be performed given their potential for harm, their unnecessary redundancy with prior testing, or the existence of comparably effective—and often less expensive—alternatives. A subspecialty society review in populating Choosing Wisely and CMS Low-Value Services identified these services as “low-value.” Reducing the use of these services is an opportunity to increase quality and lower costs.

The following services have limitations addressed in MP.177:

  • Annual Resting EKG (CPT 93000, 93005, 93010, 93015, 93016, 93017, and 93018)
  • EEG for Headaches (CPT 95812, 95813, 95816, and 95819)
  • Imaging for Eye Disease (CPT 92081, 92082, 92083, 92132, 92133, 92134, 92227, S3000)

You can find the complete list of MP.177 Low-Value Services in the redline draft version at upmchp.us/providerrldocs.

If you have questions regarding this information, contact your network manager or provider account executive. You can also call Provider Services at 1-866-918-1595.
8/2021Two important process changes effective Oct. 1, 2021
UPMC Health Plan is committed to streamlining and automating processes to improve operational efficiencies. As a result of this commitment, we will be implementing two important changes effective Oct. 1, 2021.

Discontinuation of pre-determination and ancillary services fax lines
Beginning Oct. 1, 2021, we will be discontinuing our fax lines for pre-determination (412-454-2057) and ancillary services (412-454-5255) in favor of InterQual Connect. Providers will be required to enter all prior authorization requests through Provider OnLine and the requests will be launched to InterQual Connect. If the customized criteria are met, the provider will receive an authorization in real time. If the request does not meet criteria, the authorization request will be forwarded to our Utilization Management team for review and processing—that is, following the current process. Should you need assistance with prior authorizations, please contact the Medical Management department at 1-800-425-7800 for help with the process or if you do not have access to the internet. You can also reach out to your physician account executive or Provider Services at 1-866-918-1595 with any other questions you may have.

Explanations of Payments
Beginning Oct. 1, 2021, UPMC Health Plan will no longer be mailing paper copies of Explanations of Payments (EOPs). Currently, EOPs are available through Provider OnLine for review.

You should also contact your OAA to make sure you are enrolled in electronic funds transfer (EFT). Enrolling in EFT will allow you to continue receiving reimbursement in a timely manner. Your reimbursement funds will be deposited directly into the bank account you choose.

You can log in to Provider OnLine at upmchealthplan.com/providers and submit all prior authorizations and view or print your EOPs. If you have forgotten your Provider OnLine user ID or need assistance registering as a first-time user, call our Help Desk at 1-800-937-0438.

Please feel free to reach out to your physician account executive for help finding online EOPs, setting up an EFT, or if you do not have access to the internet. Paper EOPs will be made available for those without access to the internet.
8/2021Reinstatement of member cost share for telehealth services
Since March 2020, UPMC Health Plan has waived all member cost sharing (deductibles, copays, coinsurance) for telehealth services to ensure that no member faced a barrier to accessing necessary care during the height of the COVID-19 public health emergency in our region. As hospitals and provider offices in our region have largely returned to normal operations, UPMC Health Plan will reinstate standard member cost share per the member’s plan benefit design for telehealth services effective Sept. 1, 2021.

If you are currently using telehealth with your patients, keep in mind that most UPMC Health Plan members will have cost-sharing that is the same or less than an in-person visit—our plans do not charge members more for using telehealth. This reinstatement will apply to all lines of business including UPMC for You, UPMC for Life, UPMC for Kids, and UPMC Community HealthChoices in addition to all Commercial Group, Individual, and other products.*

The only exception to this reinstatement of member cost share is for telehealth services for the diagnosis of suspected COVID-19 and ambulance telehealth services in lieu of transport during an emergency (911) dispatch. These services will continue to waive member cost share in these instances only. UPMC for Kids will reinstate member cost share for ambulance telehealth services unrelated to COVID-19 effective Oct. 4, 2021. Preventive services eligible to be provided via telehealth will continue to be covered without cost sharing.

You can find additional information on UPMC Health Plan’s COVID-19 special coverage in our COVID-19 FAQ and Appendix A COVID-19 Benefits and Cost Sharing document. Thank you for your enduring commitment to the care of our members throughout the COVID-19 public health emergency.

*While almost all of our individual and group plans include extensive telehealth benefits, some ASO/self-funded employer plans do not cover telehealth services.
8/2021Recall: Chantix (Pfizer)
Pfizer is recalling several lot numbers of Chantix 0.5 mg tablets, Chantix 1 mg tablets, and Chantix kit of 0.5 mg/1 mg, for safety reasons. Chantix is a treatment to help patients quit smoking and is intended for short-term use. Read the full text of the Chantix (Pfizer) recall.
7/2021How the Emergency Rental Assistance Program can help patients
The Emergency Rental Assistance Program (ERAP) is a new federal program that is designed to help Pennsylvanians avoid losing their home or utility service. It helps people who are having financial trouble because of COVID-19 pay for their rent and utilities.

Many Pennsylvanians may be eligible, and some could be your patients. People who are eligible for ERAP include those who pay rent on a residential property and meet other requirements related to their income and housing. The program is open right now and is accepting applications online through COMPASS or a County Assistance Office—note that some larger counties may not accept COMPASS applications.

Visit the Pennsylvania Department of Human Services ERAP page to learn more about ERAP and how this assistance opportunity could help your eligible patients.
7/2021New provider-focused site offers SDOH screening and intervention information
Our new provider website on social determinants of health (SDOH) offers information that can help you identify your patients’ needs, connect them with resources, and develop interventions.

When you visit the site, you can:

  • Learn more about SDOH and how they affect your patients’ lives.
  • Get information on implementing a SDOH screening at your clinic.
  • Learn to identify and leverage community resources.
  • View our SDOH billing guide.
  • Access a toolkit that can help you evaluate your success in addressing SDOH.

Visit upmchp.us/SDOHbillinguide to explore tools and resources that can help you address SDOH at your clinic.
7/2021Recall: Metformin ER (Viona)
Viona Pharmaceuticals Inc. is recalling two lot numbers of Metformin Hydrochloride Extended Release Tablets, USP, 750 mg, because of an impurity found in the products above levels established by the FDA. Read the full text of the Metformin ER (Viona) recall.
7/2021Mission of Mercy (MOM) Pittsburgh 2021 Dental Care Event
Are any of your patients in need of dental services? Let them know about this upcoming dental clinic where they may receive free care. The two-day event helps provide needed dental services to the underserved population in our region.

The event will take place on Oct. 22-23, 2021, at the David L. Lawrence Convention Center. Local dental professionals will donate their time, assisted by a host of clinical and nonclinical volunteers.

Please tell interested patients they can learn more at mompgh.org/patient-info.

Also, Mission of Mercy Pittsburgh needs volunteers. If you or anyone on your staff is interested, visit mompgh.org/volunteer.
6/2021Update on COVID-19 Vaccine from UPMC Health Plan
As of May 12, 2021, the U.S. Food and Drug Administration (FDA) authorized the use of the Pfizer-BioNTech vaccine in children between the ages of 12 and 15. The FDA previously authorized the vaccine for people 16 and older. Data shows the vaccine is safe in children 12 and older and is effective in preventing COVID-19. Read more about the FDA’s announcement on UPMC.com.

Please encourage your patients to get their COVID-19 vaccine as soon as possible. We can assist with locating a clinic or scheduling a COVID vaccine appointment today. Please instruct your patients to call their Health Care Concierge at 1-833-280-8510 (TTY: 711) Monday through Friday 7 a.m. to 7 p.m. and Saturday and Sunday from 8 a.m. to 5 p.m. or visit vaccine.upmc.com.

Additional COVID-19 Vaccine Resources
For current information about COVID-19, the vaccine, and helpful links and resources to share with your patients, visit:
For the most recent COVID-19 policy and billing updates from UPMC Health Plan, please read:
6/2021Recall: NP Thyroid
Acella Pharmaceuticals, LLC is recalling certain lots of 15 mg, 30 mg, 60 mg, 90 mg, and 120 mg of NP Thyroid®, Thyroid Tablets, USP [levothyroxine (T4) and liothyronine (T3)] due to it being subpotent (lower than normal or acceptable potency). Read the full text of the NP Thyroid recall.
5/2021COVID-19 Vaccine and Mammography Coverage
Patients who receive a screening mammogram shortly after receipt of a COVID-19 vaccine AND have an abnormal screening result due to swollen lymph nodes, UPMC Health Plan will waive member cost-sharing for a follow-up screening mammogram or ultrasound with their network provider when screening procedure codes are associated with an adverse vaccine reaction diagnosis (T50.B95A, T50.B95D, T50.B95S, T88.1XXA, T88.1XXD, T88.1XXS). Follow-up biopsies may be subject to additional clinical review to determine eligibility for this enhanced benefit. Only one follow-up screening will be permitted per benefit year. Coverage effective through July 20, 2021, so long as permitted under the current state and federal emergency declarations.

Our self-insured or ASO employer groups can opt out of this coverage. Coverage for out-of-network providers and facilities will follow standard rules under a member’s benefit plan, which may include higher cost-sharing or non-coverage.
5/2021Recall: Guanfacine Extended-Release 2 mg Tablets
Apotex Corp is recalling three (3) lot numbers of Guanfacine Extended-Release Tablets, NDC# 60505-3928-01, for safety reasons. Guanfacine extended-release tablets are used to treat Attention Deficit Hyperactivity Disorder (ADHD) and can be used with other stimulant medications. Read the full text of the Guanfacine Extended-Release recall.
5/2021How the American Recovery Act can help patients
The American Rescue Plan recently signed into law increases the amount of financial assistance available through Pennie (Pennsylvania’s new state-based health insurance marketplace) for customers in 2021 and 2022, improving access to coverage and care.

To make health care more accessible, Pennsylvania opened a COVID-19 Special Enrollment Period (SEP) that allows individuals to enroll in a plan until Aug. 15, 2021.

Visit pennie.com to learn more about Pennie and how it can help your patients get covered.
5/2021UPMC Presbyterian Hospital designated as a new Pituitary Tumor Center of Excellence with UPMC Health Plan
UPMC Health Plan is pleased to announce UPMC Presbyterian hospital as a newly accepted Center of Excellence in the Pituitary Tumor Center of Excellence program. This program is designed to promote high-quality outcomes and provide an optimal patient experience for UPMC Health Plan members in response to recently published Pituitary Society guidelines that demonstrated the need for Pituitary Tumor Centers of Excellence.

The UPMC Health Plan Pituitary Tumor Center of Excellence program recognizes only those surgical facilities and pituitary tumor physicians with the highest level of multidisciplinary specialty teams and technical capability. Both hospitals and pituitary tumor physicians must demonstrate high-level performance with a focus on optimal patient experience throughout the entire care process for the UPMC Health Plan member.

To learn more or if you are interested in learning how to become a Pituitary Tumor Center of Excellence, visit upmchp.us/pituitarytumorcoe.
5/2021DHS to reinstate PROMISe™ ID revalidation requirements for Medical Assistance providers
Effective June 1, 2021, the Department of Human Services (DHS) will reinstate provider revalidation requirements as applicable prior to the COVID-19 public health emergency for Medical Assistance providers.

Providers must submit PROMISe™ ID revalidation applications by the due dates indicated in 90-day and 30-day revalidation notices for revalidations due on and after June 1, 2021.

All claims for rendering, ordering, referring, or prescribing providers without an active PROMISe™ ID will be denied for claims related to coverage for UPMC for You Medicaid, UPMC for Kids CHIP, and UPMC Community HealthChoices patients.

For more information about the provider revalidation requirements, please see MA Bulletin 99-16-10 If you have questions, please call DHS at 1-800-537-8862 (option 2, option 4, option 2).
4/2021Complete the Disclosure of Ownership Form online
UPMC Health Plan is required to collect disclosure of ownership, controlling interest, and management information from providers that participate in any UPMC Health Plan network. We will be sending a letter requesting that you complete a web form that captures this information. You must complete and submit the web form within 30 days of the request. You can complete the web form now at https://upmchp.us/provider-disclosure-form. If you encounter issues with the web form or have questions, call Provider Services at 1-866-918-1595.
4/2021RxWell: Prescription-strength health
Whether your patients want to improve their emotional or physical health, RxWell has a path for them. Learn more about how RxWell can help you support your patients' health goals in the April Provider Partner Update.
4/2021UPMC Prescription for Wellness – Optimizing Physician-Prescribed Patient Engagement and Support
The Prescription for Wellness team is excited to announce the completion of our second Six Sigma project: "Optimizing Physician-Prescribed Patient Engagement and Support." Since Dec. 2019, our student team has partnered with key physician practices—in primary care, cardiology, and women’s health—to improve and optimize the functionality of the existing Prescription for Wellness order set.

Our revised order set further empowers and supports providers and engages their patients with their health, care-management, and decision-support needs. Key features, functions, and technical highlights of the new order set include:

  • Revisions to the order set reflect feedback from our physician stakeholders and represents the “voice of the customer,” which is core to Six Sigma.
  • A comprehensive and expanded menu of UPMC Health Plan resources to better meet patient/family needs:
    • "Advance care planning" is included under Shared Decision-Making Support.
    • Healthy Families coaching and pediatric case management are included under Pediatric Support.
    • Expanded prenatal and postpartum resources are included under Maternity Support.
    • Resources to support social determinants of health (education, transportation, housing, and food) are included under Patient/Family Support Services.


The enhanced order set went live on March 5, 2021. If you have any questions regarding the expanded list of resources or are interested in learning more about Prescription for Wellness, please contact Jamie Delu at RxforWellness@upmc.edu.
4/2021We've made our Explanation of Benefits more user-friendly
Our new Explanation of Benefits (EOB) layout is designed to help our UPMC for Life members easily follow, understand, and find the information they need without hassle. Read about the improvements to our EOB on page 17 of the April Provider Partner Update.
3/2021Oral Health With Pediatric Members (Recorded)
Watch UPMC Health Plan Program Director Jessica Rhodes host a webinar on improving oral health care for pediatric patients. During this hour-long session, we discussed strategies for increasing awareness and supporting the oral health of pediatric members, as well as services and resources available to providers and caregivers.

You may earn continuing medical education credits for watching this webinar.*



*Provider is responsible for verifying CME eligibility. This activity is approved for the following credit: AMA PRA Category 1 Credit™, ANCC. Other health care professionals will receive a certificate of attendance confirming the number of contact hours commensurate with the extent of participation in this activity.
3/2021Health and Wellness Items for Your UPMC for Life Patients
We’re sending your UPMC for Life Medicare patients a wellness care package to help them stay healthy this year. Care packages are expected to start arriving in early March. Here’s what’s included:
  • Tote bag
  • Blood pressure monitor
  • Digital thermometer
  • Face mask
  • Hand sanitizer
  • Pedometer
  • Pillbox
  • Nonslip socks

We’re encouraging UPMC for Life members to use the blood pressure monitor at home during telehealth or virtual appointments so they can easily share the results with providers during scheduled appointments.

Instructions for use will be included with the blood pressure monitor. We are encouraging members to reach out to their providers if they take readings between visits and have questions or concerns about the results.

A flier that explains each item will also be included with the care package. The content will vary based on plan type:

If you or your patients have questions, refer to our FAQ sheet.*

All Medicare and SNP members will get a care package with the exception of Supplement members, Select members, members who have asked not to receive promotional materials, and members in long-term care or nursing facilities.

If you have any questions, please contact your physician account executive or clinical improvement specialist. You can also call Provider Services at 1-866-918-1595.

*This FAQ is for reference only and should not be distributed to patients.
2/2021Recall: Enoxaparin Injections
Apotex Corp is recalling two batches of Enoxaparin Sodium Injection, USP due to a packaging error in some syringe barrels containing 150 mg/mL markings (corresponding to 120 mg/0.8mL strength) instead of 100 mg/mL markings (corresponding to 100 mg/mL strength) on the syringe barrel and vice versa. Read the full text of the Apotex Enoxaparin Injection recall.
2/2021Updated Coverage for Breast Cancer Screening and Imaging
On Jan. 1, 2021, UPMC Health Plan updated member cost sharing for MRIs and/or ultrasounds performed for breast cancer screening purposes in accordance with PA 2020 Act 52. There is no member cost share for preventive breast cancer screenings. View more details on the updated coverage for breast cancer screening and imaging.
2/2021Opportunities to Earn Continuing Medical Education (CME) Credits*
UPMC Health Plan is offering a series of CME-accredited webinars and podcasts. You can access these resources in the new CME presentations section of our website.

In 2021, we will also be offering live WebEx events for CME credit that allow participants to engage in discussion and ask questions. Register today for our first WebEx event of 2021, Oral Health With Pediatric Members,** on Feb. 24 from noon to 1 p.m.

Visit upmchp.us/event and click Register. You must register to attend the event. Please complete all required fields. You will receive an email confirming your registration.

*Provider is responsible for verifying CME eligibility.
**This activity is approved for AMA PRA Category 1 Credit™ and ANCC. Other health care professionals will receive a certificate of attendance confirming the number of contact hours commensurate with the extent of participation in this activity.
2/2021Important Update: InterQual Connect Implementation Date
SPECIAL NOTE: As of Feb. 8, 2021, the new implementation date for InterQual Connect will be March 22, 2021, instead of the previously communicated date of March 3, 2021.

UPMC Health Plan previously communicated that we would be implementing InterQual Connect® through Provider OnLine on Feb. 1, 2021. The date for the UPMC Health Plan implementation of InterQual Connect has been pushed back to March 22, but you can still begin preparing to use InterQual Connect by attending scheduled webinars, listening to recorded sessions, and reviewing supporting materials. Please go to upmchp.us/InterqualConnect to view the webinar schedule; additional information will be posted to this site and to Provider OnLine soon.

If you have any questions, please contact your physician account executive or call Provider Services at 1-866-918-1595.
1/2021Encourage Your UPMC for Life Patients to Get the Preventive Care They Need in 2021
Soon we will be mailing UPMC for Life members a preventive care checklist so they can keep track of their preventive care reward opportunities for 2021. And this year, we've increased the reward amount for their annual wellness visit to $30! Any UPMC for Life member who completes this visit by Dec. 31, 2021, will receive a $30 UPMC for Life Visa® Prepaid Card to use anywhere Visa debit cards are accepted. Members may also be eligible for additional rewards if they have gaps in one or more eligible preventive screenings and meet the criteria. You can help patients get their reward(s) sooner by submitting your claims promptly! See details in the latest issue of Provider Partner Update. Learn more in our preventive care incentive FAQ for providers.
1/2021UPMC for Life Removed Network Limitations for HMO Premier Rx Plans in 2021
Many of our current HMO Premier Rx plans were provider-specific plans (PSPs). That means these plans offer a limited network of participating providers that members can use for their care.

Effective Jan. 1, 2021, PSPs will only apply to members who live in Berks County and are enrolled in the HMO Rx, HMO Premier Rx, or PPO Rx Enhanced plan. All other UPMC for Life members will have access to the full UPMC for Life provider network!

This change is noted on the UPMC for Life HMO Premier Rx member ID cards. For all members (excluding those who live in Berks County and are enrolled in the plans listed above), the network name will read as UPMC Medicare Network. There will no longer be a Premier Medicare Network or UPMC/Excela Medicare Network.

Participating UPMC for Life providers can be in our online searchable provider directory. Feel free to share this link with your patients.
1/2021Recall: Anagrelide (Torrent)
Torrent Pharmaceuticals is recalling one lot of Anagrelide 1 mg capsules because of a dissolving quality issue found during routine quality testing. Anagrelide is used to treat a blood cell disorder called thrombocythemia. Read the full text of the Anagrelide (Torrent) recall.
1/2021Recall: Sildenafil (AvKare)
AvKare is recalling one lot of Sildenafil 100 mg tablets due to mispackaging issue with another medication, Trazodone 100 mg tablets. Sildenafil 100 mg is used to for the treatment of erectile dysfunction. Read the full text of the Sildenafil (AvKare) recall.
12/2020What You Need to Know About Coronavirus
UPMC Health Plan is actively monitoring the COVID-19 pandemic—including the vaccine. As you well know, this is a rapidly evolving situation, and we will continue to provide timely updates to our network providers regarding issues that affect you and our member-patients.

The COVID-19 vaccine has arrived at UPMC hospitals. Consistent with public health guidance, UPMC is first giving the vaccine to at-risk health care workers and residents of long-term care facilities. This staged delivery and prioritization for high-risk groups is being coordinated with the Pennsylvania Department of Health.

Your patients will likely have many questions for you regarding the vaccine. Please direct them to the UPMC website and the UPMC Health Plan COVID-19 website for the most up-to-date information.
12/2020Review Appendix A – COVID-19 Special Coverage and Payment Policy
Review our Appendix A - COVID-19 Special Coverage and Payment Policy for the latest policy updates.

Expand All Collapse All

2020 Announcements

12/2020Chlamydia Screening: A Call to Action Webinar Recording Available to Replay Now!
Watch Harold C. Wiesenfeld, MD, CM, host a webinar on chlamydia screenings. During the hour-long discussion we identified the local epidemiology of chlamydia infections, described the health consequences, and reviewed strategies to overcome barriers to screening. We also identified best practices to improve chlamydia screenings and presented information on the current regional chlamydia screening trends. You can also earn continuing medical education (CME) credits for watching the webinar.

Watch the webinar recording.
12/2020HMS Provider Education Webinars Are Now Available
HMS has engaged with UPMC Health Plan to perform Automatic Implantable Cardioverter Defibrillator (AICD), Place of Service (POS), Inpatient Rehabilitation Facility (IRF), and Readmission reviews. Providers can access pre-recorded training webinars on AICD, POS, IRF, and Readmission clinical claim reviews. These training webinars will help ensure that providers understand the audit and medical record submission process and will provide additional instructions on the best way to collaborate and communicate with HMS. HMS has created a dedicated email to answer questions related to the new programs or review process. You can email ProviderEdu@hms.com through Dec. 31, 2020. When using this email, please include “UPMC Health Plan” in the subject line. Any questions after Dec. 31, 2020, should be directed to the Provider Relations call center at 1-866-875-1749.

Recorded presentations:

UPMC Readmissions
Provider Outreach and Education_ UPMC Readmissions - Webinar (12.2020) on Vimeo

UPMC AICD
Provider Outreach and Education_ UPMC AICD - Webinar (12.2020) on Vimeo

UPMC IRF
Provider Outreach and Education - UPMC IRF - Webinar (12.2020) on Vimeo

UPMC POS
Provider Education Webinar- Place of Service Review (122020)1 on Vimeo
12/2020Introducing RxWell
Prescription-strength health

Over the past few months, you’ve likely become familiar with our Brain Manager mobile app—and it’s here to stay. However, Brain Manager is becoming RxWell.

RxWell will still offer techniques to help your patients build skills to support them in living their best life. This new-and-improved version builds on the successes of Brain Manager’s anxiety and depression programs and introduces a new track that deals with stress management—plus new features make using RxWell even easier for your patients. Of course, RxWell will still help patients solve problems, practice meditation techniques (e.g., deep breathing), and challenge their thought patterns so they are better equipped to self-manage these conditions.

  • Personalized tracks
    Patients will choose from three evidence-based programs—anxiety, stress, or depression—based on their needs.* RxWell will teach them mindfulness-based and cognitive behavioral therapy techniques that are tailored to their personal journeys.
  • Digital support from a health coach
    All users get access to the help and support of a UPMC Health Plan health coach who can assist them. Health coaches are there for users as they work through any challenges they encounter along the way—directly in the app.
  • Tracked progress
    Regular check-ins allow patients to identify patterns in their behavior, mood, and emotions over time.
  • No cost to patients
    We believe that good mental health improves physical well-being, but cost is often a prohibitive factor for patients. That’s why RxWell is offered to all UPMC Health Plan members at no cost.
Help your patients take the first step toward improving their mental health. Let them know they can download RxWell today from the Apple App Store or Google Play! All they need to get started is their UPMC Health Plan member ID.

Providers who use the UPMC version of Epic as their EMR can prescribe RxWell to patients right from the Epic Dashboard. When you prescribe RxWell for patients, you can monitor their use of the app. Learn more about prescribing RxWell through Epic.

Additional RxWell provider resources

*RxWell is not a crisis service. It is a tool that your patients age 18 and older can download and use at their convenience.
12/2020Good Health, Better World
UPMC Health Plan has launched a podcast that will explore how our society affects our health. Factors like access to employment, housing, and transportation are commonly called the social determinants of health. Hosted by Dr. Ellen Beckjord, AVP, Population Health and Clinical Transformation at UPMC Health Plan, the episodes feature conversations with community leaders, government officials, and UPMC Health Plan experts.

To access episodes, visit the Good Health, Better World podcast.

Date available The conversation Guests
Episode #1: 12/08/20 Improving health as a community Fr. Paul Abernathy, CEO, Neighborhood Resilience Project
Ray Prushnok, AVP Programs and Executive Director, UPMC Center for Social Impact
Episode #2: 12/15/20 Connecting to the social safety net Julie DeSeyn, Chief Program and Policy Officer, United Way of Southwestern Pennsylvania
Dan Swayze, DrPH, MBA, MEMS, VP Community Services, UPMC Health Plan and Director of Operations, UPMC Innovative Home Care Solutions
Episode #3: 12/22/20 Better jobs, better health Sec. Teresa Miller, Pennsylvania Department of Human Services
Earl Buford, CEO, Partner4Work
Dan LaVallee, Director, UPMC Center for Social Impact
Episode #4: 1/4/21 How a home helps your health Everett McClevan, CEO Community Human Services
John Lovelace, President, Government Programs, UPMC Health Plan
12/2020Chlamydia Screening: A Call to Action Webinar Recording Available to Replay Now!
Watch Harold C. Wiesenfeld, MD, CM, host a webinar on chlamydia screenings. During the hour-long discussion we identified the local epidemiology of chlamydia infections, described the health consequences, and reviewed strategies to overcome barriers to screening. We also identified best practices to improve chlamydia screenings and presented information on the current regional chlamydia screening trends. You can also earn continuing medical education (CME) credits for watching the webinar.

Watch the webinar recording.
11/2020UPMC Health Plan Provider Services Holiday Hours
We would like to let you know that our Provider Services center will be closed on Thanksgiving, Christmas, and New Years Day.
11/2020UPMC Health Plan Implementing InterQual Connect to Automate Prior Authorization Reviews
UPMC Health Plan is excited to announce that we will implement InterQual Connect® on Feb. 1, 2021, to automate medical prior authorization reviews for codes not currently managed by HealthHelp. Medical prior authorization requirements and criteria are unchanged. InterQual Connect has been customized to align with UPMC Health Plan's Medical Prior Authorization policies.

When InterQual Connect is implemented, providers will enter prior authorization requests through Provider OnLine and the requests will be launched to InterQual Connect. If the criteria are met, the provider will receive an authorization in real time. If the request does not meet criteria, the authorization request will be forwarded to the Utilization Management Team for review just as it is today.

What providers can expect:
  • Before you begin to enter the request information, you will have the ability to query the system to determine if a prior auth for the CPT code is required.
  • Clinical information will be entered and can be uploaded into InterQual Connect.
  • You can review the status of an authorization through Provider OnLine in the Auth Entry/Inquiry tab.
  • HealthHelp and pharmacy prior authorization requirements are unaffected and will continue to follow the current submission and review processes.

Important note: The requirement for prior authorizations for Home Health Services, which had previously been suspended, will be reimplemented on Feb. 1, 2021, with additional details to follow.

Contact your physician account executive for help with the process or if you do not have access to the internet. You can also reach out to Provider Services at 1-866-918-1595 with any other questions. Training and supporting materials will be available on Provider OnLine in the upcoming weeks.
11/2020Recall: Paroex Chlorhexidine Gluconate Oral Rinse USP, 0.12% (Sunstar – Oct.)
Sunstar Americas Inc. (SAI) is recalling Paroex® Chlorhexidine Gluconate Oral Rinse USP, 0.12% bearing an expiration date from 6/30/22 to 9/30/22 due to possible contamination with bacteria. This medication is used for the treatment of gingivitis (a gum disease). Read the full text of the Paroex Chlorhexidine Gluconate Oral Rinse recall.
11/2020Recall: Metformin ER (Nostrum)
Nostrum Laboratories Inc. is recalling multiple lots of Metformin Hydrochloride Extended Release Tablets, USP, 500 mg and 750 mg because of an impurity found in the products above levels established by the FDA. Metformin HCl ER tablets are used to improved blood sugar in adults with type 2 diabetes. Read the full text of the Metformin ER (Nostrum) recall.
11/2020Partners Program Gaps in Care (CGMA) Notification Center
We want you to know that the new Partners Program Gaps in Care (CGMA) capability, which instantly notifies you of important care gap and member roster status change events, is now available. These notifications will include letting you know when care gap submissions or member roster change requests submitted by you have been returned to you for further action. For more information, review our training video or FAQ document.
11/2020SNP Plan Name Change
UPMC for Life has updated our HMO SNP plan name, UPMC for Life Dual, to UPMC for Life Complete Care (HMO SNP). Our new name reflects the whole-person care and security we provide to all of our members! Members will get the same great benefits and access to high-quality care that they have always enjoyed. We will mail current members about the change to their plan name in October. The name change will take effect Jan, 1, 2021. Sample ID cards are available for your review.
11/2020Pulmonary Rehabilitation Locations for Your COPD Population
Many treatment options are available for patients with COPD; pulmonary rehabilitation is one strategy that may be ideal for your patients. Studies show that early use of pulmonary rehabilitation after hospitalization for a COPD exacerbation is associated with increased survival at one year compared with initiation after 90 days or not at all.1 This often-underutilized program can reduce patients’ symptoms, increase their ability to participate in daily activities, and improve their quality of life.

UPMC contracts with many pulmonary rehabilitation locations throughout our service area. Once you’ve referred your patient, they can schedule an appointment at the location that is most convenient for them.

You can find a complete list of UPMC Health Plan in-network pulmonary rehabilitation sites at upmchp.us/PRadultsites.

For more information about UPMC’s pulmonary rehabilitation program, visit upmc.com/services/pulmonology/our-services/respiratory/services/pulmonary-rehab.

Source:
Lindenauer PK, Stefan MS, Pekow PS, et al. Association between initiation of pulmonary rehabilitation after hospitalization for COPD and 1-year survival among Medicare beneficiaries. JAMA 2020;323(18):1813-1823.
10/2020Human Papillomavirus Diseases, Vaccination, and Your Healthcare Provider Superpower
Learn about the importance of timely HPV immunizations and how to confidently recommend them. Please view Dr. Todd Wolynn’s recorded HPV presentation, Human Papillomavirus Diseases, Vaccination, and Your Healthcare Provider Superpower. Dr. Wolynn is a pediatrician and CEO at Kids Plus Pediatrics in Pittsburgh, Pennsylvania.

This presentation offers an opportunity to review epidemiology and outcomes of HPV infection, including trends in HPV-related cancers. Learn about the importance of HPV vaccination for cancer prevention; possible changes to HPV vaccine recommendations; and recent uptake, safety, and impact data. Earn Continuing Medical Education (CME) credits.*

*In support of improving patient care, the University of Pittsburgh is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the health care team.

Physician (CME)
The University of Pittsburgh designates this enduring material activity for a maximum of 1.0 AMA PRA Category 1 Credits.* Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nursing (CNE)
The maximum number of hours awarded for this Continuing Nursing Education activity is 1.0 contact hours.
10/2020Recall: Metformin (Marksans Pharma - Oct.)
Marksans Pharma Limited, India, is recalling multiple lots of metformin hydrochloride extended-release tablets, USP, 500 and 750 mg, because of an impurity found in the products above levels established by the FDA. Metformin HCl ER tablets are used to improve blood sugar in adults with type 2 diabetes. Read the full text of the Marksans Pharma metformin recall.
10/2020Notice: ONAF Submission Updates
Beginning November 14, Optum OB Care will be making system updates to their platform. Learn more about the Optum OB Care updates.
10/2020Recall: NP Thyroid (Acella – Sept)
Acella Pharmaceuticals LLC is recalling one lot of 15 mg (Lot # M327E19-1) and one lot of 120 mg (Lot #M328F19-3) NP Thyroid®, Thyroid Tablets, USP [levothyroxine (T4) and liothyronine (T3)] due to it being subpotent (lower than normal or acceptable potency). Read the full text of the NP Thyroid recall.
10/2020UPMC for Life updates for 2021
Get the latest on UPMC for Life plan improvements, changes, and more—including:

Learn more in October's Provider Partner Update.
9/2020Recall: Nature Thyroid and WP Thyroid
RLC Labs, Inc. is recalling 483 lots of Nature-Thyroid® and WP Thyroid® due to it being subpotent (lower than normal or acceptable potency). Nature-Thyroid and WP Thyroid are used for hypothyroidism (underactive thyroid). Read the full text of the Nature Thyroid and WP Thyroid recall.
9/2020Mandatory Training for Medicare SNP Providers
The Centers for Medicare and Medicaid Services (CMS) require all Medicare Special Needs Plan (SNP) providers to complete the Model of Care Training. The Model of Care describes the structure and process by which health care services are delivered to SNP members.

For your convenience, UPMC Health Plan has developed a brief online training module on the Model of Care for our SNP product, UPMC for Life Complete Care (HMO-SNP) (formerly known as UPMC for Life Dual).

To complete the training, go to upmchp.us/snp-moc-2020. You will need your tax identification number to sign up.

If you have any questions or concerns, feel free to contact your physician account executive or call Provider Services at 1-866-918-1595.

Thank you for your continued support and the care you provide for our members!
9/2020CGMA Announcement
UPMC Health Plan has encountered an unexpected delay processing blood pressure claims for the Partners Program Gaps in Care (CGMA) system. Please be assured we have received all blood pressure claims submitted this year through this system and are prioritizing a resolution to accurately close the gap. All users will receive a notification when the issue has been corrected. At that time, appropriate reporting and status will be accessible within CGMA.

We apologize for the inconvenience and appreciate your patience.
9/2020Update on Member Cost Share for Colorectal Cancer Screenings
UPMC Health Plan is making colorectal cancer (CRC) screening easier and more accessible for our members. We are changing our billing procedures for UPMC Health Plan members who complete a fecal test with a positive result necessitating a follow-up colonoscopy. Learn about the adjustments in our billing guide and provider newsletter.
9/2020New Prior Authorization Forms for Continuous Glucose Monitors available for All Lines of Business
Continuous Glucose Monitors
9/2020Coverage of Telehealth Well-Child Visits
The COVID-19 pandemic has led to unprecedented social distancing measures. These guidelines have encouraged people to avoid leaving their homes except for essentials like groceries or urgent medical care. As such, many parents are postponing pediatric well-visits.

As indicated by the American Academy of Pediatrics (AAP) and Bright Futures periodicity schedule, UPMC Health Plan recommends that children covered by UPMC for Kids, UPMC for You, and Commercial plans see their PCP in person for annual well-visits. However, in light of current social distancing guidelines, UPMC Health Plan will consider well-child visits done via telehealth and conducted in a way that optimizes care delivery as valid well-child visits.

UPMC Health Plan will cover telehealth well-child visits for pediatric members of UPMC for Kids, UPMC for You, and Commercial plans in accordance with AAP and Bright Futures recommendations. Coverage varies based on the need for in-person well-child testing.

UPMC Health Plan has developed billing guides to assist providers in administering and billing compliant telehealth well-child visits:

EPSDT Telehealth Billing Guide
Commercial and UPMC for Kids Billing Guide

If you have any questions please contact your physician account executive or call Provider Services at 1-866-918-1595.

Note for all billing guidance for EPSDT: The EP modifier must still be placed first for EPSDT billing consideration.

Remember, these steps are not intended to supersede your preferred methods of care delivery and the provider is responsible for the appropriate billing of services.
9/2020Recall: Metformin ER (Bayshore Pharmaceuticals LLC)
Bayshore Pharmaceuticals LLC is recalling one lot of metformin HCL ER tablets, USP, 500 mg, and one lot of metformin HCL ER tablets, USP, 750 mg, because of an impurity found in the products above levels established by the FDA. Read the full text of the Bayshore Pharmaceuticals LLC Metformin ER recall.
8/2020AnywhereCare Virtual Visit
UPMC AnywhereCare, UPMC Health Plan’s telemedicine tool, offers a convenient and easy way for patients to get a medical evaluation from home or the office if they are having common conditions like a cold or sore throat, or think they are experiencing COVID-19 symptoms. Patients can have a virtual visit with a UPMC provider right from their smartphone, tablet, or computer in minutes.* Children up to age 17 can be seen by pediatric providers from UPMC Children’s Hospital of Pittsburgh.** UPMC Health Plan Members pay a $0 visit copay until Sept. 30, 2020. AnywhereCare is available 24/7 and providers can send prescriptions to the patient’s preferred pharmacy, if needed. UPMC AnywhereCare can provide general medical advice, plus treat the following conditions and more:
  • Bronchitis and coughs
  • Cold and flu symptoms
  • Diarrhea
  • Pink eye
  • Rashes
  • Seasonal allergies
  • Sinus infections
  • Tick bites
  • Vaginal yeast infections

Patients can sign up for UPMC AnywhereCare by visiting anywherecare.upmc.com or downloading the UPMC AnywhereCare app from the Apple App Store or Google Play Store.

*UPMC Health Plan members located in Pennsylvania at the time of virtual visit may select a UPMC-employed provider or a provider from Online Care Network II P.C. (OCN), subject to availability and discretion of the provider. Members located outside of Pennsylvania will receive service from OCN. OCN is not an affiliate of UPMC.

**UPMC Children’s AnywhereCare is available only to patients who are in Pennsylvania. In order for a child to have a UPMC Children’s AnywhereCare visit, the child’s parent or legal guardian must be with the child during the video portion of the visit, and the child and parent or legal guardian must be in Pennsylvania during the visit. Members located outside of Pennsylvania at the time of service may select the standard UPMC AnywhereCare module and will receive care from a provider employed or contracted by Online Care Network II P.C. (OCN) at the discretion of the provider. OCN is not an affiliate of UPMC.

†Limitations may apply for members of self-funded (ASO) plans that have opted out of coverage.
8/2020LAST CHANCE! Reminder to Encourage Members to Get Preventive Screenings
We would like to remind you of our preventive screening incentive program for your patients enrolled in a UPMC for Life plan. Members who meet the eligible HEDIS criteria and complete certain preventive services between January 1, 2020, and December 31, 2020, can receive a UPMC for Life Visa® Prepaid Card.* This card can be used everywhere that Visa debit cards are accepted. View a flier that explains the program and who qualifies. We hope you will encourage eligible UPMC for Life members to participate!

*Card is issued by MetaBank®, member FDIC, pursuant to a license from Visa USA Inc. No cash access or recurring payments. Can be used everywhere Visa debit cards are accepted. Card valid for up to six months, funds do not expire and may be available after card expiration date, fees may apply. Card terms and conditions apply.
8/2020Recall: DDAVP (Ferring–August)
Ferring Pharmaceuticals US is recalling all lots of DDAVP® Nasal Spray 10 mcg/0.1 mL, Desmopressin Acetate Nasal Spray 10 mcg/0.1 mL, and STIMATE® Nasal Spray 1.5 mg/mL because these lots are superpotent (above normal or acceptable potency). These products are used to control fluids and treat some blood disorders. Read the full text of the DDAVP (Ferring - August) recall.
8/2020August 26: Join a Live Presentation on HPV Diseases and Vaccination
Pediatrician Todd Wolynn will discuss HPV and related diseases and recommendations on HPV vaccines from the Advisory Committee on Immunization Practices. Learn about the importance of timely HPV immunizations and earn CME* credits.

Tune in to Dr. Wolynn's presentation on Wednesday, August 26 from noon to 1 p.m. Register today at https://upmchp.us/hpv.

*This activity is approved for the following credit: AMA PRA Category 1 Credit™, and ANCC. Other health care professionals will receive a certificate of attendance confirming the number of contact hours commensurate with the extent of participation in this activity.
8/2020UPMC Health Plan Now Offers a Pain Management Consultation Line for Physicians Across Pennsylvania Treating Our Members
Provider pain management consultation letter

Provider pain management consultation flier
8/2020Recall: Daptomycin (Mylan—July)
Mylan is recalling one lot (# 7605112) of daptomycin for injection, 500 mg/vial, due to particulate matter being found in one single-dose vial. Read the full text of the Mylan Daptomycin recall.
7/2020Provider Relief Fund Application Process
The U.S. Department of Health and Human Services (HHS), through the Provider Relief Fund (PRF), is distributing $15 billion to eligible Medicaid, CHIP, and dental providers. If you are a provider who is interested in learning about the application process for the PRF, you can visit www.hhs.gov/coronavirus/cares-act-provider-relief-fund for the latest information and updates.
7/2020Recall: Metformin ER (Lupin2) (Lupin Pharmaceuticals Inc.)
Lupin Pharmaceuticals Inc. is recalling all lots of Metformin Hydrochloride Extended Release Tablets, USP, 500 mg and 1000 mg, because of an impurity found in the products above levels established by the FDA. Read the full text of the Lupin Pharmaceuticals Inc. recall.
7/2020Recall: Metformin ER (Granules Pharmaceuticals Inc.)
Granules Pharmaceuticals Inc. is recalling 12 lots of Metformin HCL ER Tablets, USP, 750 mg, because of an impurity found in the products above levels established by the FDA. Read the full text of the Granules Pharmaceuticals Metformin ER recall.
7/2020UPMC Announces Patient-centered Initiative to Reduce Out-of-Pocket Prescription Drug Costs for UPMC Health Plan Members
Read the full press release.
7/2020EPSDT Periodicity Schedule Update
The EPSDT Periodicity Schedule has been updated to reflect the changes made by DHS Bulletin 99-20-04 on May 26, 2020.
7/2020Reminder to Encourage Members to Get Preventive Screenings
We would like to remind you of our preventive screening incentive program for your patients enrolled in a UPMC for Life plan. Members who meet the eligible HEDIS criteria and complete certain preventive services between January 1, 2020, and December 31, 2020, can receive a UPMC for Life Visa® Prepaid Card.* This card can be used everywhere that Visa debit cards are accepted. View a flier that explains the program and who qualifies.

We hope you will encourage eligible UPMC for Life members to participate!

*Card is issued by MetaBank®, member FDIC, pursuant to a license from Visa USA Inc. No cash access or recurring payments. Can be used everywhere Visa debit cards are accepted. Card valid for up to six months, funds do not expire and may be available after card expiration date, fees may apply. Card terms and conditions apply.
6/2020Update Your Profile With Demographic Information About Providers in Your Office
You can now give racial, ethnic, and linguistic information about providers in your office on the Provider Change Form (under the Update Race/Ethnicity and Language Information section). While providing this information is voluntary, it can help accommodate increasingly diverse patient populations who may face disparities in health care because of language and other related barriers. For example, giving patients the option to connect with providers who speak their first language can help them feel comfortable and make more informed decisions about their care.* Language and language service information will still be available through UPMC Health Plan’s provider directory. However, demographic information will only be made available to individual members upon request.

*Mullins CD, Blatt L. Health disparities: A barrier to high-quality care. Am J Health Syst Pharm. 2005 September 15; 62(18):1873–18.doi: 10.2146/ajhp050064
6/2020Dr. Schuster's and Dr. Hurford's Viewpoint: Addressing the Mental Health Impact of COVID-19
Dr. Schuster and Dr. Hurford recently co-authored an article on mental health and how it has been affected during the COVID-19 pandemic. Read the full article on Dr. Schuster's and Dr Hurford's discussion.
6/2020Telehealth Well-Child Visits
UPMC Health Plan covers telehealth well-child visits for pediatric members of UPMC for Kids, UPMC for You, and commercial plans in accordance with American Academy of Pediatrics and Bright Futures recommendations. Coverage varies based on the need for in-person well-child testing. Further coverage guidance will be provided in the coming weeks to help providers make determinations regarding appropriate types of visits.
6/2020Recall: Metformin ER (Marksans Pharma)
Marksans Pharma Limited, India, is recalling all lots of metformin hydrochloride extended-release tablets, USP, 500 mg, because of an impurity found in the products above acceptable levels established by the FDA. Read the full text of the Marksans Pharma Metformin ER recall.
6/2020Recall: Metformin ER (Teva)
Teva Pharmaceuticals USA Inc. is recalling 14 lots of metformin hydrochloride extended-release tablets, USP, 500 mg and 750 mg, because of an impurity found in the products above the acceptable levels established by the FDA. Read the full text of the Teva Pharmaceuticals Metformin ER recall.
6/2020Equitable access to patient-centered, high-quality health coverage and health care
We are aware that on June 12, 2020, HHS announced modifications to the 2016 rule implementing Section 1557 of the Affordable Care Act that, among other things, remove protections against discrimination in health coverage based on sex stereotyping and gender identity. We at the UPMC Insurance Services Division believe that every individual deserves to have equitable access to patient-centered, high-quality health coverage and health care that is provided with dignity and respect. Our commitment to nondiscrimination will not change based on the weakening of Section 1557 or the narrowing of sex- and gender-related regulatory protections. We will continue in our ongoing efforts to establish, maintain, and reinforce dignity, respect, and equality for all of our members. Toward this end, we will continue to apply coverage terms and member cost sharing equally and without regard for gender identity or gender expression. The rule will not change our existing coverage policies for gender-affirming procedures and related health services for our insurance members. In short, the UPMC Insurance Services Division will continue to do everything it can to ensure that all members continue to have access to the care and coverage they need.
6/2020UPMC Health Plan Extends Members' No-cost Access to Telehealth Services
Until September 30, 2020, UPMC Health Plan will waive all member cost sharing—including deductibles and copayments— for covered services provided via telehealth with in-network providers.* This also applies to telehealth services from UPMC AnywhereCare, FQHCs, and RHCs. UPMC Health Plan requests that POS 02, modifier 95, or both be included with all telehealth visits for any UPMC Health Plan member claim to ensure appropriate processing of $0 member cost sharing.

This extension until September 30, 2020, applies to individuals enrolled in UPMC Health Plan’s fully-insured commercial group coverage, individual ACA Marketplace plans, UPMC for Kids, and our UPMC for Life Medicare Advantage plans.

UPMC Health Plan’s technical requirements and information on covered telehealth services can be found in UPMC Health Plan policy MP.148, which is available online through our Policies and Procedures Manual. Temporary changes to our telehealth coverage policy can be found in Appendix A – COVID-19 Special Coverage and Payment Policy.

*While almost all of our individual and group plans include extensive telehealth benefits, some ASO/self-funded employer plans do not cover telehealth services. Coverage of some services may be limited following the end of the national COVID-19 emergency period.
6/2020Recall: Metformin ER (Apotex)
Apotex Corp. is recalling all lots of metformin hydrochloride extended-release tablets, USP, 500 mg, because of an impurity found in the products above the acceptable levels established by the FDA. Read the full text of the Metformin ER (Apotex) recall.
6/2020Appendix A – COVID-19 Special Coverage and Payment Policy Updates
UPMC Health Plan had temporarily extended the timely filing requirement for administrative and medical necessity provider appeals. The timely filing requirement was extended from within 30 business days of the initial denial notification to within 60 business days of the initial denial for the dates of 3/15/20 – 6/15/20. This appeals extension will end on 6/15/20. For coverage decisions made on or after 6/15/20, standard filing timelines will apply.
6/2020Recall: Metformin ER (Amneal)
Amneal Pharmaceuticals LLC is recalling all lots of metformin hydrochloride extended-release tablets, USP, 500 mg and 750 mg, because of an impurity found in the products above the acceptable levels established by the FDA. Read the full text of the Metformin ER (Amneal) recall.
6/2020Recall: NP Thyroid
Acella Pharmaceuticals LLC is recalling several lots of NP Thyroid, which have been deemed superpotent. Read the full text of the recall.
6/2020CGMA Announcement
There is a new feature in the CGMA that will allow record transfer uploads to support the removal of members from the member roster. The documents can be uploaded under the current “Verify Patient Affiliation” option by selecting “Patient is seeing a Primary Care Physician at a different office,” then choosing “YES” under "Medical Record Transfer Documentation." The documentation must include Authorization for Release of Protected Health Information, including the signature of the patient or parent/legal guardian, if the patient is younger than age 18. The name of the provider to whom the Protected Health Information is released should also be documented. Please see the FAQ within the CGMA on the provider portal documents and forms "Provider Training" section for additional information.
6/2020UPMC Health Plan Extends Members’ No-cost Access to Telehealth Services
Read the full details in our latest press release. UPMC Health Plan requests that POS 02 or modifier 95 (with any other appropriate POS) be included with all telehealth visits for any UPMC Health Plan member claim to ensure appropriate processing of $0 member cost sharing.
6/2020Medical Policy Pulled: MP.159
MP.159 was recently pulled for further consideration by multiple stakeholders that may necessitate policy refinement. More information will be posted as it becomes available.
5/2020Recommendations for Completing Medicare Annual Wellness Visits Via Telehealth
UPMC Health Plan is prioritizing the health of our Medicare members through the Medicare annual wellness visit (AWV). The AWV is integral to our members’ health because it can be used as an opportunity for gap closure. Conveniently for Medicare members, AWVs can be conducted through telehealth.

We have developed a complimentary AWV booklet and webinar to assist providers in administering and billing compliant AWVs:

Remember, these steps are not intended to supersede your preferred methods and the provider is responsible for the appropriate billing of services. You are not required to use our resource material, but it is intended to support accurate Medicare AWV documentation.

Additionally, we recognize that some Medicare and SNP members may not have video capability. In these cases, AWVs can be conducted via audio. Per CMS guidelines, an HCC screening can only be captured using synchronous audio and video. As a best practice, UPMC Health Plan is recommending that telehealth AWVs be conducted via real-time synchronous audio and video. If the AWV is audio-only, be sure to schedule an in-person AWV to capture HCCs and other screenings such as BMI, blood pressure, and HbA1C.
5/2020IMPORTANT: ALL NETWORK PROVIDERS
UPMC Health Plan is enhancing its existing claims editing procedure to improve claims processing accuracy. The effective date was previously communicated as April 1, 2020, but due to COVID-19 the go-live date was changed to June 15, 2020. Beginning June 15, 2020, UPMC Health Plan will closely review claims that have been billed with certain modifiers. These modifiers are sometimes used incorrectly to override unbundling edits. Specifically, modifier 25 should only be used to indicate separately identifiable E/M services, and modifiers 59, XE, XS, XP, and XU should only be used to indicate that a procedure or service is distinct or independent from other services performed on the same day. To align with industry standard coding guidelines and modifier descriptions, UPMC Health Plan’s review will use nationally sourced guidelines to determine the appropriateness of a modifier used to bypass code edits. This enhanced editing process will provide claim adjudication that more closely aligns with coding guidelines.
5/2020Update: SEP for those affected by COVID-19
On Tuesday, May 5, 2020, CMS released a memo announcing that there is a Special Enrollment Period (SEP) available nationwide to individuals who have been affected by COVID-19. To qualify for this special enrollment period the below criteria must be met.

An SEP exists for individuals affected by a major disaster who were unable to and did not make an election during another valid election period. This includes both enrollment and disenrollment elections.

Individuals will be considered “affected” and eligible for this SEP if they:

  • Reside, or resided at the start of the incident period, in an area for which FEMA has declared an emergency or a major disaster and has designated affected counties as being eligible to apply for individual or public level assistance;
  • Had another valid election period at the time of the incident period; and
  • Did not make an election during that other valid election period.

In addition, the SEP is available to those individuals who do not live in the affected areas but rely on help making health care decisions from friends or family members who live in the affected areas.

The SEP is available from the start of the incident (March 1) and for four full calendar months after the start of the incident period (June 30).

Individuals will be given one opportunity to make that missed election and will not be expected to provide proof that they were affected by the pandemic-related emergency.

Read the full announcement from CMS.
5/2020Encourage your UPMC for Life patients to complete their annual wellness visit from home
Through telehealth video visits, your patients can complete an annual wellness visit and talk with a doctor or provider face-to-face to get medical care and advice.

Until June 15, all UPMC for Life members have a $0 copay for telehealth services. Plus, if they complete an annual wellness visit by December 31, they will receive a $20 UPMC for Life Visa® Prepaid Card to use anywhere Visa debit cards are accepted.

Once your patients complete their annual wellness visit through telehealth and you submit a claim, it may take up to 32 days for them to receive their reward in the mail. You can help your patients get their reward sooner by submitting your claims promptly!

If you have any questions about telehealth or the preventive care rewards program, please contact your physician account executive or call Provider Services at 1-866-918-1595.

Card is issued by MetaBank®, N.A., Member FDIC, pursuant to a license from Visa U.S.A. Inc. No cash access or recurring payments. Can be used everywhere Visa debit cards are accepted. Card valid for up to 6 months, funds do not expire and may be available after card expiration date, fees may apply. Card terms and conditions apply.
5/2020Recall: Ketorolac Tromethamine Injection
Fresenius Kabi USA LLC is recalling numerous lot numbers of Ketorolac Tromethamine Injection due to the presence of particulate matter found in sample vials. Read the full text of the recall.
5/2020Recall: Tetracycline Capsules
Avet Pharmaceuticals Inc. is recalling numerous lot numbers of Tetracycline HCl Capsules, 250 and 500 mg, because of low amounts of tetracycline. Read the full text of the recall.
5/2020Recall: Nizatidine Oral Solution
Amneal Pharmaceuticals LLC is recalling three lots of Nizatidine Oral Solution, 15 mg/mL (75 mg/5 mL), because of an impurity found in the products above acceptable levels established by the FDA. Read the full text of the recall.
4/2020Most Recent FQHC/RHC Telehealth Guidance
We know you have many questions regarding telehealth services available to UPMC Health Plan members during the COVID-19 public health emergency (PHE). Federally Qualified Health Centers, Look-A-Like, and Rural Health Clinics can read more about our telehealth guidance.
4/2020Announcing UPMC Children's AnywhereCare
UPMC Health Plan’s telemedicine service—UPMC AnywhereCare—has expanded to offer care to children of all ages.

With UPMC Children’s AnywhereCare, children up to age 17 can have Virtual Urgent Care visits 24/7 with UPMC Children’s Hospital of Pittsburgh providers over live video. All your patients need is a smartphone, tablet, or computer.

UPMC Health Plan will waive all cost-sharing—including copays and deductibles—until June 15, 2020, for UPMC Health Plan members who use this service.*

UPMC Children’s AnywhereCare allows children to get medical attention quickly and safely from their home. Providers can screen children who may have been exposed to COVID-19, and they can provide treatment for these and other conditions commonly treated by a pediatrician or urgent care provider:
  • Bronchitis and coughs
  • Cold and flu symptoms
  • Diarrhea
  • Pink eye
  • Rashes
  • Sinus infections
  • Tick bites
  • Urinary tract infections

UPMC Children’s AnywhereCare is available only to patients who are in Pennsylvania.** Patients who are 3 or older can also use the standard UPMC AnywhereCare service if they need medical assistance.

We hope you will tell your patients or their parents about this convenient care option. Remember, UPMC Health Plan members can have no-cost visits through June 15. Patients who are not UPMC Health Plan members can still use UPMC Children’s AnywhereCare when they are in Pennsylvania; however, they will be charged $59 for their visits.

Patients or their parents can sign up for UPMC Children’s AnywhereCare by visiting anywherecare.upmc.com or downloading the app from the Apple App Store or Google Play.

*While almost all of our individual and group plans include extensive telehealth benefits, some ASO/self-funded employer plans do not cover telehealth services.

**UPMC Children’s AnywhereCare is available only to patients who are in Pennsylvania. In order for a child to have a UPMC Children’s AnywhereCare visit, the child’s parent or legal guardian must be with the child during the video portion of the visit, and the child and parent or legal guardian must be in Pennsylvania during the visit. If you are located outside of Pennsylvania at the time of service, you may select the standard UPMC AnywhereCare module and you will receive care from a provider employed or contracted by Online Care Network II PC (“OCN”) at the discretion of the provider. OCN is not an affiliate of UPMC.
4/2020Market withdrawal: Ranitidine (Zantac) products
The U.S. Food and Drug Administration (FDA) has requested that all manufacturers of ranitidine products withdraw the drug from the U.S. market because of an impurity found in the products above levels established by the FDA. The impurity is a chemical called N-Nitroso dimethylamine (NDMA) and it is a probable human carcinogen. Read the full text of the withdrawal.
4/2020Staying in Touch
UPMC Health Plan’s Staying in Touch events can help your patients stay connected and informed during this challenging time. Your patients can join us to hear about staying healthy, managing stress, being active, and connecting with their community—all from the comfort of home!

      •Hosted by experts on preventive medicine, mental health, and other topics.
      •Participants can stay for all or part of these 30- to 45-minute events.
      •Participants can join by phone or online.

For more information or to join an event, visit our Staying in Touch Events page.
3/2020Managing Withdrawal From Alcohol Addiction During the COVID-19 Crisis
Read our provider notice on managing withdrawal from alcohol addiction during the COVID-19 crisis.
3/2020What You Need to Know About Coronavirus
As COVID-19 makes headlines, UPMC Health Plan wants to update you, our network provider, on decisions we have made that will affect you and our members, your patients. UPMC Health Plan is actively monitoring this evolving situation and timely, appropriate care for our members remains our top priority. We are working closely with county, state, and national health agencies and organizations to ensure that we are able to share critical, accurate information that allows both you and our Provider Services team to be prepared for new developments.

Read about billing updates.

Read about telehealth services.

Read our Community Care Behavioral Health Telehealth Services update.
3/2020Phenytoin Oral Suspension USP, 125 mg/5 mL
Taro Pharmaceuticals U.S.A. Inc. is recalling these two lot numbers of Phenytoin Oral Suspension USP,125 mg/5 mL, NDC# 51672-4069-1: #327874 and #327876 (expiration date December 2020). This recall is for safety reasons. Phenytoin Oral Suspension is used to treat seizures. Read the full text of the withdrawal.
3/2020Market Withdrawal: Belviq and Belviq XR (Lorcaserin)
The U.S. Food and Drug Administration (FDA) has asked Eisai Inc.—which manufactures the weight loss drugs Belviq and Belviq XR (lorcaserin)—to withdraw the drugs from the U.S. market because of a safety clinical trial that showed an increased occurrence of cancer. Read the full text of the withdrawal.

2019 Announcements

9/2019Recall: Relpax 40 mg Tablets
Relpax is manufactured by Pfizer Inc. Two lot numbers of this medication have been recalled for safety reasons. This recall is due to the possible presence of bacteria. To date, Pfizer Inc. has not received any customer complaints or reports of adverse events related to this issue. Read the full text of the recall.
8/2019Recall: Drospirenone and Ethinyl Estradiol Tablets, USP
Jubilant Cadista Pharmaceuticals Inc. is recalling one lot of Drospirenone and Ethinyl Estradiol Tablets, USP, 3 mg/ 0.02mg due to concern that the medication will not work as well as it should. This is based on lab test results on how the medication is absorbed into the body. To date, Jubilant Cadista Pharmaceuticals Inc. has not received any reports of adverse events. Read the full text of the recall.
7/2019UPMC Health Plan would like to announce the new Hip and Knee Joint Replacement Centers of Excellence
UPMC Health Plan has established a Center of Excellence program for elective hip and knee joint replacement surgery to promote high-quality outcomes for members. The UPMC Health Plan Hip and Knee Joint Replacement Surgery Center of Excellence program recognizes surgical facilities and orthopedic surgeons that demonstrate high-quality outcomes, low complication rates, and the best patient experience for UPMC Health Plan members in need of joint replacement surgery. More information is available at upmchp.us/hip-knee-coe.
6/2019Recall: Losartan Potassium Tablets, USP
The FDA advises that patients who are on Losartan Potassium Tablets and Losartan Potassium/Hydrochlorothiazide combination tablets, USP should continue taking their medication and contact their pharmacist, physician, or medical provider for advice regarding an alternative treatment, as the risk of harm to the patient’s health may be higher if the treatment is stopped immediately without any alternative treatment. Read the full text of the recall.
6/2019Recall: Fentanyl
Heritage Pharmaceuticals Inc. is recalling lot #VEAC025 of Amikacin Sulfate Injection, USP, 1g/4 mL (250mg/mL) and lot #VPCA172 of Prochlorperazine Edisylate Injection, USP, 10mg/2mL (5mg/mL). This recall was issued because microbial growth was detected in unreleased medication. Read the full text of the recall.
6/2019Recall: Fentanyl
Alvogen Inc. is recalling two lots of Fentanyl Transdermal System 12 mcg/h transdermal patches because of mislabeling. A small number of cartons labeled 12 mcg/h Fentanyl Transdermal System patches contained 50 mcg/h patches. Read the full text of the recall.
5/2019EPSDT changes now in effect
Please note that changes have been made to the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Periodicity Schedule. These changes were made in response to the Department of Human Services (DHS) Medical Assistance Bulletins released on August 1, 2018, and are relevant to all Medical Assistance providers. View the updated EPSDT Periodicity Schedule and UPMC for You billing guide.
5/2019Recall: Losartan Potassium Tablets, USP
Based on the available information, the risk of developing cancer following long-term use of the product containing high levels of the impurity NMBA cannot be ruled out. The FDA advises that Consumers should contact their doctor for further guidance and potential change of treatment before they stop taking the product. Read the full text of the recall.
4/2019Recall: Valsartan and Amlodipine/Valsartan
Aurobindo Pharma USA Inc. is recalling 39 lots of Valsartan and Amlodipine/Valsartan tablets because of an impurity found in the product. The impurity—N-nitrosodiethylamine (NDEA)—is classified as a probable human carcinogen. Read the full text of the recall.
4/2019Recall: Losartan Potassium Tablets, USP
Legacy Pharmaceutical Packaging, LLC is recalling 3 repackaged lots of Losartan Potassium Tablets, USP, 50 mg. This recall was prompted due to Torrent Pharmaceuticals LTD issuing a voluntary nationwide recall of Losartan Tablets, USP, because of an impurity found in the product. Read the full text of the recall.
4/2019Recall: Losartan Potassium Tablets, USP
Legacy Pharmaceutical Packaging, LLC is recalling 40 repackaged lots of Losartan Potassium Tablets, USP, 25 mg, 50 mg, and 100 mg. This recall was prompted due to Camber Pharmaceuticals, Inc. issuing a voluntary nationwide recall of Losartan Tablets, USP, because of an impurity found in the product. Read the full text of the recall.
3/2019Recall: Losartan/Hydrochlorothiazide (Macleods)
Macleods Pharmaceuticals Limited is recalling one lot number of Losartan/Hydrochlorothiazide because of an impurity found in the product. The impurity—N-nitrosodiethylamine (NDEA)—is classified as a probable human carcinogen. Read the full text of the recall.
3/2019Recall: Irbesartan and Irbesartan/Hydrochlorothiazide
Prinston Pharmaceutical Inc., dba Solco Healthcare LLC, is recalling 1 lot of Irbesartan and 7 lots of Irbesartan/Hydrochlorothiazide because of an impurity found in the product. The impurity—N-nitrosodiethylamine (NDEA)—is classified as a probable human carcinogen. Read the full text of the recall.
3/2019Recall: Losartan and Losartan/HCTZ (Torrent)
Torrent Pharmaceuticals Limited is recalling 10 lot numbers of Losartan and 6 lot numbers of Losartan/Hydrochlorothiazide because of an impurity found in the product. The impurity—N-nitrosodiethylamine (NDEA)—is classified as a probable human carcinogen. Read the full text of the recall.
1/2019Recall: Valsartan
Aurobindo Pharma USA Inc. is recalling 80 lots of Valsartan, Amlodipine and Valsartan, and Valsartan and Hydrochlorothiazide because of an impurity found in the product. Read the full text of the recall.
1/2019Recall: Losartan (Torrent)
Torrent Pharmaceuticals Limited is recalling 10 lot numbers of Losartan because of an impurity found in the product. The impurity—N-nitrosodiethylamine (NDEA)—is classified as a probable human carcinogen. Read the full text of the recall.

2018 Announcements

12/2018Recall: Infant Ibuprofen
Tris Pharma Inc. is recalling three lots of Infants’ Ibuprofen Concentrated Oral Suspension, USP (NSAID) 50 mg per 1.25 mL. The recalled lots have been found to potentially contain higher concentrations of ibuprofen. No problems linked to this recall have been reported. Read the full text of the recall.
12/2018Recall: Sodium Chloride Injection .09%
Fresenius Kabi USA is recalling 163 lots of Sodium Chloride Injection 0.9% vials because of mislabeling. The product insert states that stoppers for both the 10 ml and 20 ml vials do not contain rubber latex. However, the product is being recalled because the stoppers have been found to contain natural rubber latex. Read the full text of the recall.
12/2018Recall: Losartan HCTZ
Mylan Pharmaceuticals is recalling select lot numbers of Valsartan, Amlodipine and Valsartan, and Valsartan and Hydrochlorothiazide because of an impurity found in the product. The impurity—N-nitrosodiethylamine (NDEA)—is classified as a probable human carcinogen. Read the full text of the recall.
11/2018Recall: Losartan HCTZ
Sandoz Inc. is recalling lot number JB8912 of Losartan Hydrochlorothiazide because of an impurity found in the drug product. No problems linked to this recall have been reported so far. Read the full text of the recall.
11/2018Recall: Ortho-Novum
Janssen Pharmaceuticals Inc. is recalling several lots of Ortho-Novum 7/7/7 and 1/35 tablets because the patient information provided inside affected packages does not include the appropriate instructions for the dispenser. The Ortho-Novum product itself remains safe and effective for use with the appropriate dispenser instructions. Read the full text of the recall.
11/2018Recall: Ibesartan
ScieGen Pharmaceuticals is voluntarily recalling all unexpired lots of Irbesartan because of an impurity found in the product. Companies affected by this recall include Golden State Medical Supply Inc. (GSMS) and Westminster Pharmaceuticals. Read the full text of the recall.
8/2018Recall: Valsartan and Valsartan/Hydrochlorothiazide (HCTZ)
Solco Healthcare, Teva Pharmaceuticals Industry Ltd., Major Pharmaceuticals, Camber Pharmaceuticals, Northwind Pharmaceuticals, and several repackaging manufacturers are voluntarily recalling all unexpired lots of Valsartan and Valsartan/Hydrochlorothiazide because of an impurity found in the product. Read the full text of the recall.
8/2018Recall: Levothyroxine or Liothyronine (Thyroid Tablets)
Westminster Pharmaceuticals, LLC is voluntarily recalling all unexpired lot numbers of Levothyroxine and Liothyronine (Thyroid Tablets, USP) 15 mg, 30 mg, 60 mg, 90 mg, and 120 mg. These products are being recalled as a precaution because they were manufactured using active pharmaceutical ingredients sourced prior to a 2017 inspection that found one supplier to have deficiencies with Current Good Manufacturing Practices (cGMP). Read the full text of the recall.
8/2018Recall: Valsartan and Valsartan/Hydrochlorothiazide
Solco Healthcare, Teva Pharmaceuticals Industry Ltd., and Major Pharmaceuticals are voluntarily recalling all unexpired lots of Valsartan and Valsartan/Hydrochlorothiazide because of an impurity found in the product. Read the full text of the recall.
6/2018Provider Manual Update
The UPMC for You (Medical Assistance) chapter of the UPMC Health Plan Provider Manual has been updated with an effective date of July 1, 2018. To view the most recent changes, visit our Provider Manual page.
6/2018Recall: Fluticasone Propionate Nasal Spray
Apotex Corp. is voluntarily recalling one lot of Fluticasone Propionate Nasal Spray due to containing small glass particles. Read the full text of the recall.
6/2018Recall: Naloxone Hydrochloride Injection
Hospira Inc. is voluntarily recalling two lots of Naloxone Hydrochloride Injection because of the potential presence of embedded and loose particulate matter on the syringe plunger. Read the full text of the recall.
5/2018Recall: Ampicillin and Sulbactam for Injection
AuroMedics Pharma LLC is voluntarily recalling two lots of Ampicillin and Sulbactam for Injection because customers noticed red particulate matter in the product. Read the full text of the recall.
3/2018Recall: Methylprednisolone Sodium Succinate for Injection
Sagent Pharmaceuticals Ltd. has initiated this voluntary recall of Methylprednisolone Sodium Succinate for Injection, USP to the user level due to the discovery of high out-of-specification impurity results. Read the full text of the recall.
3/2018 Alcohol Use and Alcohol Problems Event
We want to help you, help your patients. UPMC Health Plan is hosting an event to discuss and share resources that help your patients and their families cope with an alcohol problem. Learn more about the event.
2/2018 Reminder: Update PROMISe IDs
Effective January 1, 2018, UPMC for You Medicaid, UPMC for Kids CHIP, and UPMC for Life Dual Medicare SNP providers must have updated PROMISe ID numbers to render, order/refer, or prescribe items or services to patients covered under those plans. If you do not have a PROMISe ID, claims will be denied.
Don’t wait — enroll online now!
2/2018 Align yourself with thought leaders
Our leaders are applying their expertise, along with creativity and rigor, to some of the most challenging problems in health care delivery and financing. Our latest research findings can give you a unique perspective and new ideas on current topics.
To review the latest thought leadership lineup, please visit http://upmchp.us/research.
1/2018 Obstetrical Needs Assessment (OBNA) form submission
Please submit the obstetrical needs assessment form (OBNA) electronically via Optum OB Care or EPIC. Provider offices without capability for EPIC submission should use Optum OB Care. Faxed copies will not be accepted.
1/2018 Recall: Clopidogrel 75 mg tablets
International Laboratories, LLC is voluntarily recalling Lot# 117099A of Clopidogrel tablets, USP 75 mg, packaged in bottles of 30 tablets, to the consumer level due to mislabeling. The product is labeled as Clopidogrel tablets USP 75 mg but may contain Clopidogrel 75 mg or Simvastatin 10 mg. Read the full text of the recall.
1/2018 Obstetrical Needs Assessment (OBNA) form submission
Please submit the obstetrical needs assessment form (OBNA) electronically via Optum OB Care or EPIC. Provider offices without capability for EPIC submission should use Optum OB Care. Faxed copies will not be accepted.

2017 Announcements

9/2017 Recall: All liquid products manufactured by PharmaTechLLC
As a precautionary measure, the distribution firms Leader Brand, Major Pharmaceuticals, and Rugby Laboratories are jointly issuing a nationwide voluntary recall of all lots within expiry of all liquid products manufactured by PharmaTechLLC at its FDA registered facility in Davie, FL, due to possible product contamination. Read the full text of the recall.
9/2017 Recall: Vancomycin Hydrochloride for Injection, USP, 750 mg/vial
Vancomycin Hydrochloride for Injection is manufactured by Hospira. The company recalled one lot number of the medication for safety reasons. This recall is because of the presence of particulate matter. Read the full text of the recall.
9/2017 Recall: Lorazepam Oral Concentrate, USP 2 mg/ml
Lorazepam Oral Concentrate, USP 2mg/ml is being recalled for safety reasons. The dropper may have dose markings in reverse number order, no dose markings, or dose markings that are shifted. Read the full text of the recall.
9/2017 Recall: Pravastatin 40 mg tablet
Pravastatin 40 mg tablets are being recalled for safety reasons. The product may also be labeled as Pravastatin SodiumTablets USP 40 mg but contains Bupropion Hydrochloride XL 300 mg tablets. Read the full text of the recall.
8/2017 Prescription Drug Misuse and Addiction Resources
Like you, we’re here for our community. UPMC Health Plan is hosting an event to discuss and share resources that help your patients and their families cope with a prescription drug problem. Stay educated about the prescription drug epidemic. Learn more about the event.
6/2017 Recall: Eliquis (apixaban) 5 mg tablet
Eliquis (apixaban) 5 mg tablets are being recalled as a precautionary measure from a customer complaint that a bottle labeled as Eliquis 5 mg was found to contain Eliquis 2.5 mg tablets. Read the full text of the recall.
6/2017 Recall: Mibelas 24 Fe Chewable Tablets
Mibelas 24 Fe Chewable Tablets are being recalled for safety reasons because these tablets may be out of sequence and missing expiry/lot information. Read the full text of the recall.
4/2017 Recall: EpiPen and EpiPen Jr Auto-Injectors (epinephrine injection)
EpiPen® and EpiPen® Jr Auto-Injectors are being recalled for safety reasons because these devices may contain a defective part that may result in the devices’ failure to activate. Read the full text of the recall with a list of lot numbers.