IMPORTANT UPDATE: Extending the current UPMC Health Plan utilization model for selected MSK, cardiology, and radiology codes

Jan. 2022Important Notices
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.

Recent Announcements

PA DOH Antibiotic Stewardship Resources

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

Medical device correction: Omnipod (Insulet – May 2026)

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

Clinical documentation required for medical policy prior authorizations

As you know, UPMC Health Plan requires certain clinical documentation/notes in support of a request for prior authorization for the listed procedures below in accordance with its established policies and procedures, in addition to CMS requirements that medical record documentation must support the medical necessity of the services requested.
Jun. 2026Important Notices