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Announcements

5/2022COVID-19 vaccine booster updates
The U.S. Food and Drug Administration authorized a second booster dose of either the Pfizer-BioNTech or the Moderna COVID-19 vaccines for adults age 50 and older and individuals age 12 and over who are moderately to severely immunocompromised.

The agency amended the emergency use authorizations as follows1:
  • A second booster dose of the Pfizer-BioNTech COVID-19 Vaccine or Moderna COVID-19 Vaccine may be administered to individuals 50 years of age and older at least four months after receipt of a first booster dose of any authorized or approved COVID-19 vaccine.
  • A second booster dose of the Pfizer-BioNTech COVID-19 Vaccine or Moderna COVID-19 Vaccine may be administered to individuals who are moderately to severely immunocompromised at least four months after receipt of a first booster dose of any authorized or approved COVID-19 vaccine. The Pfizer-BioNTech COVID-19 Vaccine may be in administered to individuals 12 years of age and older and the Moderna COVID-19 Vaccine may be administered to individuals 18 years of age and older.
  • A second booster dose of either the Pfizer-BioNTech or the Moderna COVID-19 vaccines may be administered at least four months after the first booster to individuals who have received one primary dose of the Johnson & Johnson/Janssen Vaccine with one subsequent booster of any COVID-19 vaccine.


For the most recent guidance on who can receive a booster shot, as well as specific recommendations for those who are moderately to severely immunocompromised, visit the CDC and FDA websites.

UPMC Health Plan is committed to ensuring that every eligible member has access to COVID-19 vaccines and resources to answer their questions about the COVID-19 vaccines. Health Plan members can find answers on our COVID-19 FAQ page—whether they are now eligible for boosters considering their first dose.

UPMC offers online scheduling for the COVID-19 vaccines; UPMC Health Plan members can also schedule by calling a Health Care Concierge at the number on the back of their ID card.

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

6/2022UPMC for You is expanding across Pennsylvania in September!
We are excited to announce that the Pennsylvania Department of Human Services (PA-DHS) has awarded UPMC for You a Medicaid Managed Care Contract for all five Physical HealthChoices zones across the Commonwealth of Pennsylvania. UPMC for You currently serves the Northwest, Southwest, and Lehigh/Capital HealthChoices zones and will expand into the Northeast and Southeast zones, effective Sept. 1, 2022.*

After June 22, 2022*, your Medicaid patients will receive a letter from PA-DHS to let them know about the Medicaid Managed Care Organizations (MCOs) selected to service their HealthChoices zones. Please look for a provider toolkit arriving in the mail in the coming weeks, explaining various value-added benefits for your patients and a variety of materials to display in your office. You can also review a list of frequently asked questions at upmchp.us/ProviderFAQ.

*Go-live implementation dates and communication timelines are subject to change at discretion of the Pennsylvania Department of Human Services.
6/2022Recall: Anagrelide
Teva has recalled one lot of Anagrelide 0.5 mg capsules. Anagrelide is used to treat conditions that cause a patient’s platelet count to be too high. The drug is being recalled because testing showed that it took longer than expected for the medication to dissolve in the body. Read the full text of the Anagrelide recall.
6/2022UPMC Health Plan achieves high marks in provider satisfaction
95% of physician practice survey respondents indicate they would recommend UPMC Health Plan to other physician practices. In addition, respondents ranked UPMC Health Plan in the 93rd percentile or higher in 17 of 19 questions from the annual Provider Satisfaction Survey.

UPMC Health Plan contracts with SPH Analytics to conduct an annual Provider Satisfaction Survey. You may be invited to participate in the 2022 survey that will begin in mid-August. The survey will ask for feedback on your experience with UPMC Health Plan as well as other health plans you work with. Watch for an invitation in the mail or via email in August.
6/2022Promote the UPMC Pathways for Students Career Fair
The UPMC Pathways for Students Career Fair is an opportunity for the class of 2022 and other recent graduates to explore a range of career opportunities at UPMC. Family and friends are also encouraged to attend this career fair and celebration.

When: Wednesday, June 29, from 3 to 7 p.m.
Where: Heinz Field in the FedEx Great Hall (free parking in Gold Lot 1A)
What: Networking, resume assistance, interview guidance, meetings with hiring managers, opportunities to apply for open positions at UPMC. After networking, everyone can celebrate with food, a live DJ, and giveaways.

Interested attendees can register at upmchp.us/studentcareers.
5/2022Recall: Accupril Tablets
Pfizer is recalling batches of Accupril tablets (Quinapril HCl – 10 mg, 20 mg, and 40 mg) due to the presence of a nitrosamine, Nnitrosoquinapril, that was observed in recent testing at levels above the Acceptable Daily Intake (ADI) level. Read the full text of the Accupril Tablets recall.
5/2022Home health telehealth update
As you know, home health services have been approved for coverage via telehealth since the onset of the COVID-19 pandemic. Based on the usage and success of home health telehealth, UPMC Health Plan has expanded the option as a permanent telehealth service when appropriate. Effective April 1, 2022, UPMC Health Plan updated the Telehealth – MP.148 policy to include home health services as a telehealth option for members as indicated in the policy. This update is a result of a collaboration between many UPMC Health Plan departments. Services covered by the policy include observation, training or education in skilled nursing, medical social work, physical therapy, occupational therapy, speech therapy, and home health aid. A telehealth visit must include audio and video components.

Home health telehealth has successfully assisted home health agencies with current staff shortages and allows members to conveniently access services in the comfort of their home in a timely and effective manner.
5/2022Important update: InterQual Connect prior authorizations – MSK/Ortho reviews
Effective June 1, 2022, prior authorizations for MSK/orthopedic procedures previously managed by HealthHelp will resume formal clinical reviews. Please ensure that prior authorization requests are submitted with complete information to increase the likelihood that they will be auto-approved, eliminating the need for manual review and delayed authorizations.
5/2022Recall: Insulin Glargine
Mylan Pharmaceuticals Inc., a Viatris company, has recalled one batch of Insulin Glargine (Insulin glargine-yfgn) Injection, 100 units/mL (U-100). It is being recalled because some of the vials may be missing their label. The missing label could lead to a mix-up or confusion for people who use more than one type of insulin, such as short- and long-acting. Read the full text of the Insulin Glargine recall.
5/2022Recall: Orphenadrine Citrate 100 mg
Sandoz is recalling 13 lots of Orphenadrine Citrate 100 mg Extended Release (ER) Tablets due to the presence of a nitrosamine (N-methyl-N-nitroso-2-[(2-methylphenyl)phenylmethoxy]ethanamine (NMOA or Nitroso-Orphenadrine)) impurity, which may exceed the U.S. Food and Drug Administration (FDA)'s Acceptable Daily Intake limit. Read the full text of the Sandoz Orphenadrine Citrate recall.
5/2022CME webinar: Behavioral Health in Primary Care – How UPMC Health Plan Can Help
May is National Mental Health Awareness Month, and you are invited to a timely webinar on the topic. Recorded live March 10, 2022, the webinar:

  • Gives an overview of behavioral health in primary care, including background, prevalence, and best practices.
  • Explains available supports and services at UPMC Health Plan, including the RxWell app and Behavioral Health Condition and Case Management.
  • Describes how you can prescribe these and other UPMC Health Plan supports and services with UPMC Prescription for Wellness.
  • Details reimbursement and incentives for depression screening.


Presenters:
  • Alin Severance, MD, Medical Director, Behavioral Health Services, UPMC Health Plan; Associate Medical Director, Community Care Behavioral Health Organization
  • Jamie Delu, RRT, Director, Prescription for Wellness, UPMC Health Plan
  • Laura Francis, MSW, LSW, Program Director, Behavioral Integration, UPMC Health Plan
  • Rebecca Knoll, MPH, Director, Quality Provider Performance, UPMC Health Plan
  • Tanuja Tripurana, BTech in Mechanical Engineering, Senior Manager, RxWell, UPMC Health Plan


Register or log in.

You may earn continuing medical education (CME) credits for attending this webinar.*

*Provider is responsible for verifying CME eligibility.

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.
4/2022Recall: Accuretic tablets
Pfizer is recalling batches of Accuretic™ tablets (quinapril HCl and hydrochlorothiazide – 10 mg/12.5 mg, 20 mg/12.5 mg, and 20 mg/25 mg), quinapril HCl and hydrochlorothiazide (20 mg/25 mg), and quinapril and hydrochlorothiazide tablets (20 mg/12.5 mg and 20 mg/25 mg) due to the presence of a nitrosamine, N-nitroso-quinapril, above the Acceptable Daily Intake (ADI) level. Read the full text of the Accuretic tablets recall.
4/2022Recall: Sodium Chloride for Injection
B. Braun Medical Inc. (B. Braun) has recalled five lot numbers of 0.9% Sodium Chloride for injection USP 250mL in Excel. This is due to fluid leakage or low fill volume of the respective containers. Read the full text of the Sodium Chloride for Injection recall.
4/2022Pediatric Behavioral Health: Best Practices for Primary Care (recorded live)
Watch the webinar recorded live Nov. 17, 2021, where Alin Severance, MD, medical director of Behavioral Health Services at UPMC Health Plan and associate medical director at Community Care Behavioral Health Organization, discusses the importance of pediatric behavioral health best practices for primary care.

During this hourlong session, Dr. Severance reviews the epidemiology of behavioral health conditions in children and adolescents, best practices for screening and treatment for the most common behavioral health disorders and when to seek referrals, and the range of referral and consultation resources available to support the care of pediatric patients.

Register or log in to listen to the webinar.

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

*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.

Provider is responsible for verifying CME eligibility.
4/2022Talk to patients about organ donation through UPMC
UPMC Transplant Services is one of the country’s oldest and largest transplant programs. The program has expanded to offer life-saving transplant care in Pittsburgh, Erie, and central Pennsylvania; and transplant evaluations in north central, central, and northwestern Pennsylvania.

UPMC is enhancing access to transplant services but is asking for your support to help those on the waiting list get life-saving organs. The need for more people to register as organ donors remains dire.

According to Health Resources & Services Administration (HRSA) data, there are more than 100,000 people on the national transplant waiting list, and every nine minutes another person is added to the list.1 Sadly, 17 people die each day waiting for an organ transplant.2

You can help make sure that people on the waiting list get the life-saving transplant they need by talking to your patients about the importance of organ donation. At the end of their lives, they can give life to others. Encourage your patients to register as an organ, eye, or tissue donor at registerme.org/UPMC.

1. Health Resources & Services Administration. Organ donation statistics. Reviewed March 2022. Accessed March 14, 2022. organdonor.gov/learn/organ-donation-statistics#:~:text=people%20die%20each%20day%20waiting,YOU%20can%20help.
2. Ibid.
4/2022Updated security requirement
In accordance with NACHA updates to the ACH Security Framework data protection requirements, effective May 1, 2022, UPMC will be eliminating the inclusion of Bank Routing and Account information from the “BPR – Financial Information” segment of the Electronic Remittance Advice (835 ERA). No other information like the Payment Method Code (BPR04) or the Check/EFT Trace Number (TRN02) will be impacted by this compliance change. Read more about the security requirement.
3/2022Telehealth guidance
UPMC Health Plan would like to update providers on new guidance released for Place of Service for telehealth. Read the telehealth guidance.
3/2022CME webinar: Best Practices for Pediatric Healthy Weight Management
Please join us for a live, CME-accredited webinar Wednesday, May 25, from noon to 1 p.m.

The presentation will include an overview of best practices for pediatric healthy weight management, including the following topics:
  • Nutrition, obesity/BMI, and healthy families.
  • HEDIS® measures and Quality.
  • How you can prescribe UPMC Health Plan supports and services using UPMC Prescription for Wellness.

Presented by:
  • Robert Rutkowski, MD, FAAP, Co-lead Physician, UPMC Children’s Community Pediatrics, Shenango; Medical Director, UPMC Children’s Express Care, South Fayette; Medical Director, Practice Transformation and Provider Relations at UPMC Health Plan
  • Star Klamut, RN, BSN, Project Director, Provider Performance Quality at UPMC Health Plan
  • Jamie Delu, RRT, Director, Prescription for Wellness at UPMC Health Plan

Register now at upmchp.us/onweb. This webinar will be recorded.

You may earn continuing medical education (CME) credits for attending this webinar.*

*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.

Provider is responsible for verifying CME eligibility.
3/2022Over-the-counter COVID-19 testing reimbursement
UPMC Health Plan is now providing reimbursement for rapid over-the-counter (OTC) COVID-19 tests for members covered by UPMC for You, UPMC for Kids, and UPMC Community HealthChoices (UPMC CHC). Coverage includes up to eight FDA-authorized OTC rapid tests every 28 days per each covered individual when purchased directly from a retail store or retailer website. When purchasing through a participating pharmacy, coverage is limited to two COVID-19 OTC tests per seven days for up to eight tests in a 28-day time period. In the coming months, as announced by President Biden, UPMC for Life and other Medicare plans will have some coverage for home-based rapid antigen tests. More information will be shared as soon as we have details for that coverage. If your patients haven’t already, they can also go to covidtests.gov and get four free tests for their household.

Both rapid and laboratory tests that are ordered or administered by a health care provider following an individualized clinical assessment, including for those who may need them due to underlying medical conditions, will continue to be covered for our members as well. OTC tests that require laboratory processing are eligible for coverage only with a prescription.


COVID-19 OTC test reimbursement forms can only be used for tests that are self-administered and self-read. The forms may not be used for COVID-19 tests that are ordered or administered by a health care provider.

Members can learn more about their covered benefits on our COVID-19 website.

If you have any questions regarding this reimbursement process, please call Provider Services at 1-866-918-1595.
3/2022Important update: InterQual Connect Prior Authorizations
As a reminder, prior authorizations for imaging and cardio procedures previously managed by Health Help will resume formal clinical reviews effective March 1, 2022. At this time there is no change to MSK/Orthopedic reviews.

Please ensure that prior authorization requests are submitted with complete information to increase the likelihood that they will be auto approved, eliminating the need for manual review and delayed authorizations.
2/2022New requirements for physician extenders
Effective Jan. 7, 2022, Pennsylvania Department of Human Services (DHS) has changed the PROMISe ID requirements for physician extenders. CRNPs and physician assistants (PAs) are now required to register with PA DHS to render, refer, order or prescribe services for UPMC for You, UPMC Community HealthChoices, and UPMC for Kids members. Once implemented, UPMC Health Plan will follow DHS claim denial guidelines for nonregistered CRNPs and PAs. For further information or to enroll, please visit PA DHS online or call the UPMC Health Plan Provider Services team at 1-866-918-1595.
2/2022Webinar: Pediatric Behavioral Health – Best Practices for Primary Care (recorded live)
Watch the webinar recorded live Nov. 17, 2021, where Alin Severance, MD, medical director of Behavioral Health Services at UPMC Health Plan and associate medical director at Community Care Behavioral Health Organization, discusses the importance of pediatric behavioral health best practices for primary care.

During this hourlong session, Dr. Severance reviews the epidemiology of behavioral health conditions in children and adolescents, best practices for screening and treatment for the most common behavioral health disorders and when to seek referrals, and the range of referral and consultation resources available to support the care of pediatric patients.

Register or log in

You may earn continuing medical education (CME) credits for attending this webinar.*

*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.

*Provider is responsible for verifying CME eligibility.
2/2022Recall: Semglee
Mylan Pharmaceuticals Inc., a Viatris company, is recalling a batch of Semglee® (insulin glargine injection), 100 units/ml (U-100), 3mL prefilled pens, which are packaged in a labelled carton of five pens. Read the full text of the Semglee recall.
1/2022IMPORTANT UPDATE: Extending the current UPMC Health Plan utilization model for selected MSK, cardiology, and radiology codes
Prior authorizations for procedures and imaging that were previously managed by HealthHelp (diagnostic imaging, cardiology, and MSK) will be approved until March 1st without review of clinical documentation. However, prior authorization requests must still be submitted for related claims to be paid. Please ensure that requests are submitted with complete information to increase the likelihood that they will meet criteria and be auto approved, eliminating the need for manual review and delayed authorizations.

Do not delay medically necessary care or services because you are waiting for an authorization.

Thanks in advance for your cooperation and collaboration.

Please keep in mind that an authorization is not a guarantee of payment for services rendered.
1/2022CME webinar: Behavioral Health in Primary Care: How UPMC Health Plan Can Help
Please join us for a live, CME-accredited webinar Thursday, March 10, from noon to 1 p.m.

The presentation will include an overview of behavioral health in primary care, including the following topics:
  • Background, prevalence, and best practices
  • Available supports and services at UPMC Health Plan such as the RxWell app, behavioral health condition management, and case management
  • How to prescribe these and other UPMC Health Plan supports and services with UPMC Prescription for Wellness
  • Reimbursement and potential incentives for depression screening

Presented by:
  • Alin Severance, MD, Medical Director, Behavioral Health Services at UPMC Health Plan; Associate Medical Director, Community Care Behavioral Health Organization
  • Jamie Delu, RRT, Director, Prescription for Wellness at UPMC Health Plan
  • Laura Francis, MSW, LSW, Program Director, Behavioral Integration at UPMC Health Plan
  • Rebecca Knoll, MPH, Director, Quality Provider Performance at UPMC Health Plan
  • Tanuja Tripurana, BTech in Mechanical Engineering, Senior Manager, RxWell at UPMC Health Plan

Register now at upmchp.us/bhpc. This webinar will be recorded.

You may earn continuing medical education (CME) credits for attending this webinar.*

*Provider is responsible for verifying CME eligibility. This activity is approved for the following credit: AMA PRA Category 1 Credit™, ANCC, and ASWB. 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.
1/2022Webinar: Pediatric Dyslipidemias: Screening, Diagnosis, and Management in the Primary Care Setting (recorded live)
Watch the webinar recorded live May 19, 2021, where Brenda Mendizábal, MD, MS, Director of Pediatric Preventive Cardiology, UPMC Children’s Hospital of Pittsburgh, addresses improving the management of pediatric dyslipidemias.

During this hourlong session, Dr. Mendizábal discusses identifying children at greatest risk for accelerated atherosclerosis, formulating a plan for providing care to children with dyslipidemias, and the role of the pediatric preventive cardiologist.

Register or log in to listen to the webinar.

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

*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.

Provider is responsible for verifying CME eligibility.
1/2022Recall: Metformin ER
Viona Pharmaceuticals Inc. has recalled 33 lots of Metformin Hydrochloride Extended-Release Tablets, USP, 750 mg because an impurity found in the products is above levels established by the Food and Drug Administration. Read the full text of the Metformin ER recall.
1/2022Recall: Clobetasol
Taro Pharmaceuticals USA Inc. has recalled one lot (AC13786, Exp. 12/2022) of Clobetasol Propionate Ointment USP, 0.05% packaged in 60 g tubes. Clobetasol is a topical corticosteroid that is used to relieve inflammation and itching. Read the full text of the Clobetasol recall.
1/2022Recall: Nitroglycerin Spray
Padagis US LLC has recalled Nitroglycerin Lingual Spray because of a complaint that the product may not work correctly. Nitroglycerin Lingual Spray is used for acute (in-the-moment) relief of an attack or to prevent chest pain caused by coronary artery disease in adult patients. Read the full text of the Nitroglycerin Spray recall.
1/2022Requirements under the No Surprises Act
As of Jan. 1, 2022, Section 116 of the Federal Consolidation Appropriations Act, which addresses provider directory accuracy, became effective. It regulates the responsibility of both payers and providers regarding provider information that appears in payer provider directories. Referred to as the No Surprises Act (NSA), the Act requires the following as it applies to provider directories (paraphrased):

  • Of Payers
    • That payers verify and update the provider directory information not less frequently than once every 90 days.
    • That payers establish a process to remove providers from directories if the payer is unable to verify the providers’ information.
  • Of Providers
    • Providers shall submit provider directory information to a plan or issuers, at a minimum:
      • When providers terminate a network agreement.
      • When there are material changes to the content of provider directory information.
      • At any other time (including upon the request of such issuer or plan).

Additionally, current CMS/DHS/PID regulations are still in effect and contractual obligations to notify UPMC Health Plan of providers’ changes still apply. Incentive payment eligibility is contingent upon quarterly provider directory verification.

At the beginning of each quarter, LexisNexis will be reaching out through one or more of its three communication channels (phone, fax, or online) to verify that your provider information is accurate.

Alternatively, you can view your information by the following methods:

  1. Searching the online directory for your name at upmchealthplan.com/find. You can make updates to your information at upmchealthplan.com/providers/change.html.
  2. Searching Provider OnLine under "Reports," "Office Information Sheet." Changes can be noted on the sheet and returned to the email address below. (If this section is not available to you, you can request access via your online administrator.)

If you have any questions, have trouble with your updates, or if your contact information has changed, contact your physician account executive or email providernetworkinquiries@upmc.edu.
1/2022CME webinar: Pediatric Oral First Aid
February is National Children’s Dental Health Month, and you are invited to a timely webinar on the topic. Please join us for the live, CME-accredited webinar on Wednesday, Feb. 16, from noon to 1 p.m. Brian Martin, DMD, MHCDS, Vice President of Medical Affairs and President, Pennsylvania Pediatric Health Network (CIN), UPMC Children’s Hospital of Pittsburgh; Shannon McDonald, RDH, PHDHP, Dental Care Manager; Dana Shaffer, RDH, PHDHP, Dental Care Manager; and Doree Rossey, RDH, PHDHP, Dental Care Manager Supervisor, will discuss the different types of pediatric oral health emergencies, oral care routines to help families understand the importance of good oral health, and treatment modalities in dental offices to address various dental issues including mouthguard use. This webinar will be recorded.

Register now at upmchp.us/ohwebex.

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

*Providers are responsible for verifying CME eligibility. 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.
1/2022New CME webinar on quality measures available
Providers may earn CME credits by viewing our latest webinar on the importance of implementing quality measures within the framework of clinical practice. Using this knowledge is an excellent way for a clinical practice to thrive by helping to improve efficiency, patient safety, and clinical outcomes.

Watch the Quality Measures for Primary Care Providers webinar on demand to get a “101" on quality measures. During the presentation, participants will learn:

  • The concepts of quality and value and how they apply to health care.
  • The components of a quality measure.
  • HEDIS, CAHPS, and NCQA roles in quality measures.
  • Best practices for select pediatric, behavioral, and adult measures.

Quality Reference Resources are included as part of the presentation.

Watch Quality Measures for Primary Care Providers on demand. You may earn continuing medical education credits (CME) for watching this webinar.*

*Provider is responsible for verifying CME eligibility. This activity is approved for the following credit: AMA PRA Category 1 Credit™ and AAPA Category 1 CME. 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.
1/2022CME webinar: Addiction Care for the Non-Addiction Provider Part 4 – Overview of Management and Available Resources
Please join us for a live, CME-accredited webinar Wednesday, March 23, from noon to 1 p.m. Michael Lynch, MD, Medical Director, Pittsburgh Poison Center; Medical Director, UPMC Health Plan Substance Use Disorder Services; and Assistant Professor of Emergency Medicine, Toxicology, Pediatrics, and Addiction at the University of Pittsburgh, will summarize the continuum of care for a patient with a substance use disorder (SUD) in an outpatient setting, including available resources to assist non-addiction providers with meeting the needs of these patients. This will be part 4 of a 4-part series.

During the program, Dr. Lynch will:

  • Present data regarding the prevalence and impact of SUDs on society and health care.
  • Provide an overview of feasible screening, brief intervention, and referral to treatment processes, including reimbursement opportunities.
  • Review basic medical management principles for patients with SUDs.
  • Describe existing support and referral resources available to Pennsylvania providers to connect patients to ongoing care.

Register today at upmchp.us/ac4. This webinar will be recorded.

You may earn continuing medical education credits for attending this event.*

*Provider is responsible for verifying CME eligibility. This activity is approved for the following credit: AMA PRA Category 1 Credit™, ANCC, and ASWB. 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.
1/2022COVID-19 vaccines – No cost share for members
UPMC Health Plan believes that vaccination is important, helps protect our communities, and saves lives. We advocate that all who can be vaccinated should be vaccinated. Since the first Emergency Use Authorizations were granted, the COVID-19 vaccine has been covered as a preventive service at no cost for UPMC Health Plan members. This applies to all of our comprehensive medical coverage products, including UPMC for Life, UPMC for Life Complete Care, UPMC for You, UPMC for Kids, UPMC Community HealthChoices, and all UPMC commercial group and individual (Pennie/Marketplace) products.

CMS has provided billing guidance and vaccine toolkits that can be found at cms.gov/COVIDvax. As of Jan. 1, 2022, vaccination claims for members with UPMC for Life (Medicare Advantage) should go to UPMC Health Plan, not Medicare Fee-For-Service. To learn more, visit our provider FAQ and Appendix A for more information.
1/2022UPMC Health Plan recommends COVID-19 booster shots for all who are eligible
The CDC recently indicated that everyone ages 16 and older can get a COVID-19 booster shot.

  • 16-17-year-olds can only get a Pfizer vaccine booster.
  • Those 18 and older can get a booster with any of the COVID-19 vaccines.

Pfizer and Moderna boosters should be given at least six months after the second vaccine. The Johnson & Johnson booster should be given at least two months after the first vaccine.

To read more about booster shots, visit the CDC's webpage.

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

1/2022COVID-19 vaccine booster updates
There are three COVID-19 vaccines authorized or approved for use in the United States to prevent COVID-19. Pfizer-BioNTech or Moderna (COVID-19 mRNA vaccines) are preferred under CDC guidance. You may get Johnson & Johnson’s Janssen COVID-19 vaccine in some situations. The FDA has authorized boosters for Pfizer-BioNTech, Moderna and J&J vaccines and "mix and match" dosing for boosters. This means that you may receive your primary vaccine and your booster from different manufacturers.

On Jan. 3, 2022, the U.S. Food and Drug Administration amended the emergency use authorization (EUA) for the Pfizer-BioNTech COVID-19 Vaccine to:

  • Expand the use of a single booster dose to include use in individuals 12 through 15 years of age.
  • Shorten the time between the completion of primary vaccination of the Pfizer-BioNTech COVID-19 Vaccine and a booster dose to at least five months.
  • Allow for a third primary series dose for certain immunocompromised children 5 through 11 years of age.

For the most recent guidance on who can receive a booster shot, visit the CDC or FDA.

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:

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2021 Announcements

12/2021Updated blood lead reference value for children
The Centers for Disease Control and Prevention (CDC) recently updated its blood lead reference value (BLRV) from 5 µg/dL to 3.5 µg/dL in response to a recommendation by the Lead Exposure Prevention and Advisory Committee (LEPAC).

The BLRV aims to identify children with higher levels of lead in their blood compared to most children, based on the 97.5th percentile of the blood lead level (BLL) distribution in U.S. children ages 1 to 5 years.1 However, the CDC states that there is no safe BLL in children and that even low levels of lead in blood can affect learning and academic achievement and have permanent effects. It is critical for providers to partner with parents and caregivers to help prevent exposure and lower a child’s lead level, if necessary. To connect members with case management and for environmental lead investigation support, please contact the UPMC Pediatric Care Management Department. You can email a referral to pedscasemanagement@upmc.edu or call 1-866-778-6073 and select “pediatrics.”

Learn more
For more information about BLL in children, visit cdc.gov/nceh/lead/prevention/blood-lead-levels.htm. You can also view the UPMC Health Plan Lead Screening Provider Tip Sheet.

Source
1Centers for Disease Control and Prevention. CDC updates blood lead reference value for children. Last reviewed Oct. 28, 2021. Accessed Nov. 2, 2021. cdc.gov/media/releases/2021/p1028-blood-lead.html
12/2021Reminder: Updates to policies MP.PA.131-138
Per November’s issue of Provider Partner Update, UPMC Health Plan will implement the new policies listed below effective Jan. 1, 2022.

  • MP.PA.131 Cardiac Defibrillator, Wearable
  • MP.PA.132 Vertebral Augmentation
  • MP.PA.133 Knee Arthroplasty
  • MP.PA.134 Spinal Fusion
  • MP.PA.135 Lumbar Spinal Decompression
  • MP.PA.136 Shoulder Procedures
  • MP.PA.137 Cardiac Devices, Implantable Defibrillator and Pacemaker
  • MP.PA.138 Hip Arthroplasty

As a reminder, authorization is required for all members regardless of age and for all lines of business.

It is the policy of UPMC Insurance Services Division to cover services when medically necessary and covered by the member’s benefit plan for the specific indications detailed in the policies.

For the complete list of indications and limitations, refer to the above-referenced policies in the UPMC Health Plan policies and procedures manual.

If you have any questions regarding this update, please contact your network manager, provider account executive or call Provider Services at 1-866-918-1595.
12/2021Lab Benefit Manager update
Lab Benefit Manager implementation has been moved from Jan. 1, 2022, to Feb. 1, 2022. This will give our valued providers additional preparation time. Please contact your physician account executive with any questions.
12/2021New Extended Network collaboration provides access to Cigna PPO Network1 providers while outside UPMC Health Plan service area
Members enrolled in our commercial plans have full access to all UPMC-owned providers, many community-based doctors and hospitals, and a national Extended Network outside of the UPMC Health Plan service area. As of Jan. 1, 2022, this national network will move from PHCS/MultiPlan to the Cigna PPO Network for members outside the UPMC Health Plan service area and Ohio.2,3 Provider contracts outside the service area affected by this change will be contacted by the UPMC Health Plan Network Development team. UPMC for Kids travel network will remain with PHCS/MultiPlan. If any member is seeking care in Ohio, they will continue to access care through the SuperMed Preferred Provider Organization Network. To determine if a provider is in the extended network, you can use our online directory at upmchealthplan.com/find. All members will receive new ID cards.

Learn more about this coverage and other important updates in this month’s Provider Partner Update. If you have any questions, please reach out to your physician account executive or call Provider Services at 1-866-918-1595.

1The Cigna PPO Network refers to the health care providers (doctors, hospitals, specialists) contracted as part of the Cigna PPO Network for Shared Administration.

2Cigna is an independent company and is not affiliated with UPMC Health Plan Inc. and its affiliates. Access to the Cigna PPO Network is available through Cigna's contractual relationship with UPMC Health Plan Inc. All Cigna products are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property Inc. 3UPMC Health Plan members residing in Bucks, Chester, Delaware, Franklin, Fulton, Juniata, Mifflin, Montgomery, Montour, and Philadelphia counties in Pennsylvania; all other states except Ohio; Garrett and Allegany counties in Maryland; and Chautauqua, Cattaraugus, and Allegany counties in New York can access the Cigna PPO Network as their primary network. UPMC Health Plan commercial members and their dependents who reside in Ohio or while traveling in the state will continue to access care through the SuperMed PPO Network and, while traveling outside of the state of Ohio, can also utilize the Cigna PPO Network.
12/2021Webinar: Food Security Screening & Intervention in Pediatric Populations (live and recorded)
Watch the live recorded online webinar held on Aug. 18, 2021, where Dr. Jodi Krall, PhD, project director, UPMC Children’s Hospital of Pittsburgh, Community Health Division, and Sarah Elizabeth Morrow, program manager for Collaborative Health at UPMC Health Plan, discuss the importance of food security screenings for pediatric populations. During this hour-long session, they discussed the relationship between food insecurity and children’s health, current approaches for addressing food insecurity in pediatrics, and how to identify and advise on food insecurity.

Register or log in to listen to the webinar.

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

*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.

Provider is responsible for verifying CME eligibility.
12/2021DHS reinstated PROMISe ID revalidation requirements for Medical Assistance providers
Provider revalidation requirements resumed in June 2021. They apply to providers who provide, order, refer, or prescribe services for Medical Assistance, Community HealthChoices, or CHIP members. These providers must enroll every service location where they see members with the Department of Human Services (DHS) and obtain a PROMISe™ ID (also known as Medicaid ID or MPI). Revalidation of these locations is required every five years.

All service locations must comply to avoid claim denials.

Because of the COVID-19 public health emergency (PHE), a section 1135 waiver allowed DHS to apply certain temporary flexibilities related to provider enrollment and revalidation requirements.

As of June 1, 2021, DHS reinstated provider revalidation requirements as applicable prior to the COVID-19 PHE.

Take action: Submit revalidation applications.

Providers will receive notification from DHS 90 days and 30 days in advance of their enrollment expiration date. PROMISe ID revalidation applications must be submitted by the due dates indicated in 90-day and 30-day notices for revalidations due on and after June 1, 2021.

If you are past the revalidation date, you need to take immediate action to correct this. Failure to do so will result in denial of claims for service locations that have not be revalidated or do not have an active PROMISe ID. Claim denials
All claims for rendering, ordering, referring, or prescribing providers without an active PROMISe ID will be denied for UPMC for You (Medicaid), UPMC for Kids (CHIP), and UPMC Community HealthChoices patients.

Know where to go
Providers should log in to PROMISe to check the revalidation dates of each service location and submit revalidation applications at least 60 days prior to the revalidation dates. Providers should also enroll for any locations that are not listed in PROMISe. Enrollment (revalidation) applications are located on the DHS website.

Learn more
Providers can read Medical Assistance Bulletin 99-21-01 to learn more about the restoration of provider revalidation requirements.

Questions?
Please contact DHS with questions about the following:
  • Provider enrollment
  • Revalidation
  • Enrollment fees
  • Site visits
  • Criminal background checks

You can reach DHS regarding these matters at 1-800-537-8862 (option 2, option 4, option 2).
12/2021CME webinar: E&M Documentation for Diagnosis Reporting (recorded)
Watch UPMC Health Plan Program Director Marlana Tice and Lead Physician Educator Brenda Stevenson discuss improving E&M documentation for diagnosis reporting. The hour-long session covers these topics:
  • Provider documentation requirements and guidelines for E&M and ICD-10-CM diagnosis reporting
  • The connection between the new 2021 E&M documentation guidelines and ICD-10-CM reporting
  • The importance of reporting diagnoses for severity of illness
  • Risk adjustment overviews and risk adjustment data validation (RADV) audits
  • Diagnoses that are problematic to RADV audits in terms of provider documentation and ICD-10-CM code assignment

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

Watch the E&M Documentation for Diagnosis Reporting 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.
12/2021Recall: Enoxaparin (Sandoz – Dec.)
Sandoz Inc. is recalling one lot (SAB06761A, Exp. 04/2023) due to a portion of the lot being exposed to a higher temperature, which may affect the effectiveness of the drug. Enoxaparin Sodium injection is a blood thinner that is used to prevent and treat blood clots and heart attacks. Read the full text of the Enoxaparin (Sandoz – Dec.) recall.
12/2021New telehealth POS code starting Jan. 1, 2022
CMS released guidelines for a new Place of Service (POS) Code for telehealth as well as a new definition for POS 02.

POS 02: Telehealth Provided Other than in Patient’s Home Descriptor: The patient location when health services and health related services are provided or received, through telecommunication technology. POS 02 should be used when the patient is not located in their home when receiving health services or health related services through telecommunication technology.

POS 10: Telehealth Provided in Patient’s Home Descriptor: The patient location when health services and health related services are provided or received through telecommunication technology. POS 10 should be used when the patient is located in their home (which is a location other than a hospital or other facility where the patient receives care in a private residence) when receiving health services or health related services through telecommunication technology.

As of Jan. 1, 2022, UPMC Health Plan will recognize and accept POS 10 the updated definition for POS 02 for all lines of business. There is no change to reimbursement associated with the POS codes.

The UPMC Health Plan Telehealth Policy MP.148 will reflect this effective Jan. 1, 2022.

The provider of care is ultimately responsible for providing accurate and compliant information on all submission of claims and/or billing information.
12/2021Added clarity re. DHS guidance on telehealth services for FQHCs and RHCs providers
Services rendered through telehealth at Federally Qualified Health Centers, Federally Qualified Health Centers Look-Alike Centers, or Rural Health Clinics by UPMC for You, UPMC for Kids¸ and UPMC Community HealthChoices Medical Assistance participating providers will be paid at the same rate as if they were rendered in person, using standard office visit codes (e.g., HCPCS code T1015) with place of service 02.

The telehealth service must be rendered in conformance with the full description of the procedure code, in a clinically appropriate manner, and to the extent that it would have been rendered if the visit had occurred in person. No additional payment will be made for the technology used to render telehealth services. Consistent with Pennsylvania DHS guidance (Bulletin 99-21-06) that applies to all HealthChoices Medical Assistance Providers, UPMC Health Plan will allow for the use of telephone-only services where video technology is not available.
12/2021Skilled nursing facility prior authorizations
Effective Dec. 16, 2021, UPMC Health Plan will waive the initial prior authorization requirements for members who are being transferred from an inpatient setting to a skilled nursing facility (SNF). Inpatient providers are still required to notify UPMC Health Plan of the planned SNF transfer, but the initial placement request will not be reviewed for prior authorization based on medical necessity.

UPMC Health Plan will coordinate with the receiving SNF to perform a medical necessity review for ongoing placement following the initial authorization, consistent with UPMC Health Plan’s standard policy for placements. SNFs must still adhere to UPMC Health Plan’s authorization policies, including those regarding the review of continuing/ongoing placements. Out of network authorizations for skilled nursing facilities may be authorized due to capacity and placement requirements. However, out-of-network authorization is not automatic and UPMC Health Plan must be notified of any request for out of network transfers. UPMC Health Plan staff will work with the requesting provider to locate an available in-network facility or make arrangements with an out-of-network facility as necessary.
12/2021CME presentation: Healthcare Inequalities and Addressing Disparities (recorded)
Listen to Dr. Nicholas DeGregorio and Dr. Johanna Vidal-Phelan discuss the nature and root causes of health care inequities and the key pillars for addressing disparities. They will also examine the relationships among health disparities, social determinants of health, and health outcomes and review UPMC Health Plan initiatives to provide suggestions to reduce health care disparities and improve health equity.

Review the presentation

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.
12/2021Mandatory 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.

You must complete this training by March 1, 2022.

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).

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

The training is also available on Provider OnLine. You can find it under Provider Training in the Documents and Forms section.

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!
12/2021Q1 provider directory updates required
As you know, UPMC Health Plan requires all providers to verify their provider directory information at least every 90 days (quarterly). This allows us to comply with CMS/DHS/PID requirements to maintain accurate directories—as well as the federal No Surprises Act (effective Jan. 1, 2022). Accurate directories are the primary way our members find in-network care.

UPMC Health Plan quality programs also require provider directory verification as a condition of participation and payment. In addition, failure to attest every 90 days may result in further action per your participating provider agreement.

Ways to keep your information current
At the beginning of each quarter, LexisNexis will be reaching out through one or more of its three communication channels (phone, fax, or online) to verify that your provider information is accurate.

You can visit the provider directory to ensure that your provider information and office details are up to date and accurate. Here is the information that must be reviewed/updated/verified:
  • Ability to accept new patients
  • Street address
  • Phone number
  • Office hours
  • Products accepted
  • Hospital privileges
  • Whether your practice offers telehealth services (optional but encouraged)
  • Any other information that affects your availability to our members

You can view your information by searching the online directory for your name at upmchealthplan.com/find. You can make updates to your information at upmchealthplan.com/providers/change.html.

If you have any questions, need help with your updates, or need to change your contact information, please contact your physician account executive or email providernetworkinquiries@upmc.edu.

Thank you for your support in this ongoing effort!

LexisNexis cannot change your product participation or the services contracted by your practice. If you have questions or concerns regarding product participation or contracted services, contact your physician account executive.
12/2021Stay up to date on the Philips Respironics recall
In June 2021, Philips Respironics issued a global, voluntary recall for some of its sleep and respiratory care products. The recall aims to address identified potential health risks related to the polyester-based polyurethane (PE-PUR) sound abatement foam in these devices.

Philips is facilitating the replacement of repaired equipment, as it becomes available, for users who register affected devices with the company. Alternative temporary/loaner equipment is currently limited for durable medical equipment (DME) providers due to increased demand.

Philips updates durable medical equipment (DME) providers on various aspects of the current remediation status. DME providers and other providers can visit the Philips' recall website for current information on the recall. UPMC Health Plan members can contact us at 1-844-220-4785 if they have additional questions.
11/2021Children ages 5 to 11 are now eligible to receive the COVID-19 vaccine
Children 5 years old and older can now receive the Pfizer-BioNTech COVID-19 Vaccine. Children 5 through 11 years old will receive a separate vaccine formulation, denoted with an orange cap, of the Pfizer-BioNTech COVID-19 Vaccine that has one-third the dose given to adolescents and adults, and will receive the vaccine with a smaller needle. An overview of the description of the differences in the adult/adolescent formulation and pediatric formulation is available on the CDC website.

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:

Children between the ages of 2 and 4 years old, other unvaccinated children 5 years or older and adults should continue to wear a mask in public spaces and around people they don’t live with.1

As a trusted resource of factual information about the safety and effectiveness of the vaccine, health care providers are critical to helping combat myths and fears. Visit the CDC website to learn more about how to answer parents’ and caregivers’ questions about the COVID-19 vaccines.

Source
1Centers for Disease Control and Prevention. COVID-19 Vaccine FAQs for Healthcare Professionals. Last reviewed: Nov. 8, 2021. Nov. 8, 2021. cdc.gov/vaccines/covid-19/planning/children.html#clinical-training-education
11/2021CME webinar: Addiction Care for the Non-Addiction Provider, Part 3 – Opioid Use Disorder Management
Please join us for a live, CME-accredited webinar on Feb. 23 from noon to 1 p.m. Michael Lynch, MD, Medical Director, Pittsburgh Poison Center; Medical Director, UPMC Health Plan Substance Use Disorder Services; and Assistant Professor of Emergency Medicine, Toxicology, Pediatrics, and Addiction at the University of Pittsburgh, will discuss opioid use disorder management for the non-addiction provider. This will be part 3 of a 4-part series.

During the program, Dr. Lynch will:

  • Present national and PA-specific opioid overdose death trends.
  • Describe basis for recommending medication treatment for opioid use disorder (MOUD).
  • Discuss different MOUD options.
  • Review buprenorphine induction and maintenance therapy including special populations and drug screens.
  • Summarize CDC naloxone prescribing recommendations.
  • Name several available resources for assistance with patient care and referral.

Register today at upmchp.us/ac3. This webinar will be recorded.

You can plan ahead and register for Addiction Care for the Non-Addiction Provider, Part 4:
Dates Times Registration
March 23 Noon to 1 p.m. upmchp.us/ac4

You may earn continuing medical education credits for attending this event.*

*Provider is responsible for verifying CME eligibility. 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.
11/2021Available now: New CGMA capability
Effective Monday, Nov. 29, a new CGMA capability allows users to upload medical record documentation to close the BMI percentile gap for the Weight Assessment for Children/Adolescents (WCC) measure. Users will now see "Upload" under the action column on the member gaps page for this measure and will be able to submit documentation for review.
11/2021Recall: Irbesartan Tablets
Lupin Pharmaceuticals Inc. is recalling batches of Irbesartan Tablets, USP and Irbesartan and Hydrochlorothiazide Tablets, USP due to the presence of an impurity that may cause cancer. This is a medicine that treats high blood pressure as well as nephropathy (kidney disease) caused by type 2 diabetes. Read the full text of the Irbesartan recall.
11/2021CME webinar: Addiction Care for the Non-Addiction Provider, Part 2 – Alcohol Use Disorder Management
Please join us for a live, CME-accredited webinar on Jan. 19 from noon to 1 p.m. Michael Lynch, MD, Medical Director, Pittsburgh Poison Center; Medical Director, UPMC Health Plan Substance Use Disorder Services; and Assistant Professor of Emergency Medicine, Toxicology, Pediatrics, and Addiction at the University of Pittsburgh, will discuss alcohol use disorder management for the non-addiction provider. This will be part 2 of a 4-part series.

During the program, Dr. Lynch will:

  • Present the prevalence and impact of alcohol use disorder (AUD) and withdrawal.
  • Describe AUD screening and withdrawal assessment.
  • Review medical management of alcohol withdrawal and AUD.
  • Explore non-medication interventions for patients with AUD.
Register today at upmchp.us/ac2. This webinar will be recorded.

You can plan ahead and register for Addiction Care for the Non-Addiction Provider, Parts 3 and 4:
Dates Times Registration
Feb. 23 Noon to 1 p.m. upmchp.us/ac3
March 23 Noon to 1 p.m. upmchp.us/ac4
You may earn continuing medical education credits for attending this event.*

*Provider is responsible for verifying CME eligibility. 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.
11/2021CME webinar: Addiction Care for the Non-Addiction Provider, Part 1 – Screening and Initial Intervention
Please join us for a live, CME-accredited webinar on Dec. 8 from noon to 1 p.m. Michael Lynch, MD, Medical Director, Pittsburgh Poison Center; Medical Director, UPMC Health Plan Substance Use Disorder Services; and Assistant Professor of Emergency Medicine, Toxicology, Pediatrics, and Addiction at the University of Pittsburgh will discuss screening and initial intervention for the non-addiction provider. This will be part 1 of a 4-part series.

During the program, Dr. Lynch will:

  • Describe the current effects of substance use disorders on morbidity and mortality.
  • Discuss the physiology of addiction.
  • Review prevalence data and stigma/language associated with SUD and its care.
  • Present available screening tools and processes.
  • Describe practices that reduce harm and morbidity associated with substance use.
  • Discuss implementation barriers and opportunities.
Register today at upmchp.us/ac1.

You may earn continuing medical education credits for attending this event.*

*Provider is responsible for verifying CME eligibility. 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.
11/2021Pharyngitis testing now available at Quest Diagnostics
You can send your patients of all ages who are UPMC Health Plan members to any Quest Diagnostics Patient Service Center (PSC) in Pennsylvania for pharyngitis tests, including the following:

Learn more

11/2021U.S. Antibiotic Awareness Week Nov. 18–24
Join the Centers for Disease Control and Prevention (CDC) in observing U.S. Antibiotic Awareness Week (USAAW) Nov. 18–24. This annual observance raises awareness of the threat of antibiotic resistance and the importance of appropriate antibiotic use.

Learn about other ways you can participate in USAAW to improve antibiotic prescribing and protect your patients.

Review the Be Antibiotics Aware Partner Toolkit.
11/2021Recall: Losartan Potassium Tablets, USP
Jubilant Cadista Pharmaceuticals Inc. is withdrawing all quantities of unexpired lots of Losartan Potassium Tablets, USP; and Losartan Potassium and Hydrochlorothiazide Tablets, USP due to the presence of an impurity that may increase the risk of cancer. Read the full text of the Losartan Potassium Tablets, USP recall.
11/2021Recall: Lidocaine (Teligent)
Teligent is recalling a few lots of Lidocaine Hydrochloride Topical Solution 4% (40 mg/mL), due to the lot being super potent (higher than normal or acceptable potency). Read the full text of the Lidocaine (Teligent) recall.
11/2021FDA, CDC greenlight Moderna and J&J boosters, allow “mix and match”
Federal guidance and authorization now include boosters for Moderna and Johnson & Johnson/Janssen (J&J) vaccines, joining previous authorization of Pfizer boosters, as well as the ability to "mix and match" doses from different manufacturers.

The CDC says all three COVID-19 vaccines continue to work well at reducing the risk of severe disease, hospitalization, and death. A booster dose of vaccine is not unusual and is a common way to ensure the immune system remains prepared; children and adults regularly receive boosters of common vaccinations like Tdap (tetanus, diphtheria, and pertussis) or MMR (measles-mumps-rubella).

Who is now eligible for boosters?
While all three available vaccines have been authorized as booster doses, eligibility and timing varies based on the brand of vaccine you originally received.

You received the J&J vaccine initially:
You are eligible for a booster if you received your first dose of at least two (2) months ago AND:
  • You are 18 years of age or older
You received the Pfizer or Moderna vaccine initially:
You are eligible for a booster if you received your second dose at least six (6) months ago AND:
  • You are 65 years of age or older
  • OR you are 18 years of age or older and residing in a long-term care setting
  • OR you are 18 years of age or older and have a high-risk underlying medical condition
  • OR you are 18 years of age or older and are at increased risk for COVID-19 exposure and transmission because of occupational or institutional setting
If you are eligible for a booster based on the above, you may select ANY of the three vaccine brands for your booster.

Under this new guidance, health care workers are eligible for any of the three vaccine boosters.

What about “mix and match” dosing for boosters?
The FDA on Wednesday, Oct. 20, authorized boosters for Moderna and J&J vaccines and "mix and match" dosing for boosters. This means that you may receive your primary vaccine and your booster from different manufacturers. That authorization was followed on Thursday, Oct. 21, by a unanimous recommendation from the ACIP, the CDC's advisory committee on immunization practices, and endorsement by the director of the CDC. While the authorized dosage and formulation for any booster will be the same no matter which primary vaccine you received, the timing of your booster may change based on whether you received Pfizer/Moderna or the J&J primary vaccine.

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

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:

10/2021Advancing health equity through community-based solutions
You are invited to join an advocacy session on Tuesday, Nov. 16, 2021, from noon to 5 p.m. through the 2021 Magee-Womens Summit. This session will highlight the critical importance of tackling tough issues with communities who are facing adversity.

You are also invited to attend the full three-day CME-accredited conference, which will cover an advocacy session on Nov. 16 and move to two full days of research and clinically focused keynote talks and panel discussions on Nov. 17 and 18.

Learn more about the conference and to register at mageesummit.org/conference.

The conference will be held in-person as well as virtually. Please register by Nov. 4, 2021.
10/2021Pediatric telehealth quality measures
As we wind down 2021, UPMC Health Plan would like to remind providers of several quality measures that may be closed via telehealth.

For pediatricians, there are four:

  • Child and Adolescent Well-Care Visits (WCV), 30 months and over
  • Nutrition Counseling (WCC)
  • Physical Activity Counseling (WCC)
  • BMI (WCC)
Nutrition Counseling, Physical Activity, and BMI can be conducted outside of a WCV during any other visit type via telehealth, such as a sick visit.
10/2021Recall: Glucagon Emergency Kit
Eli Lilly and Company is recalling the Glucagon Emergency Kit lot D239382D, expiration April 2022, due to a product complaint that the vial of Glucagon is in a liquid form instead of a powder form. Read the full text of the Glucagon Emergency Kit recall.
10/2021CME webinar: Pediatric Behavioral Health – Best Practices for Primary Care
Please join us for a live, CME-accredited webinar on Nov. 17 from noon to 1 p.m. Dr. Alin Severance, Medical Director of Behavioral Health Services at UPMC Health Plan and Associate Medical Director at Community Care Behavioral Health Organization, will discuss ways to implement pediatric behavioral health best practices for primary care.

Register now at upmchp.us/bhwebex.

Find additional details on the event flier and share with interested colleagues.

*Providers are responsible for verifying CME eligibility. 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.
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.
9/2021CDC 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
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.

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.