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
August 2026 UPMC for You and UPMC Community HealthChoices Formulary Updates
Effective Aug. 15, 2026, UPMC for You and UPMC Community HealthChoices are updating their formularies.Jul. 2026Pharmacy Updates
Give feedback on your experience with UPMC Health Plan
You may be invited to participate in a 2026 Press Ganey provider satisfaction survey, which will begin next month. This survey will be given to a random sampling of in-network primary care providers.Jul. 2026Important Notices
Prescription for Wellness - Leveraging Insurance Carrier Resources to Optimize Patient Engagement Outcomes!
Prescription for Wellness is a nationally recognized, Six Sigma-developed best practice system that provides a convenient and effective way for providers to prescribe resources and support offered by UPMC Health Plan to their patients who are UPMC Health Plan members.Jul. 2026Education/Webinars