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
Pause in Prior Authorization Policies
On April 1, 2025, we announced that UPMC Health Plan would start requiring prior authorization for certain services. Please note that we are delaying or changing the implementation of prior authorization for some of these services, as described below.May 2025Important Notices
May is Mental Health Awareness Month
“Turn Awareness into Action”Mental Health America founded Mental Health Month in 1949, and since that time, every May has been a time to unite millions of people to promote awareness, provide vital resources, and advocate for everyones mental well-being. 1 in 5 people will experience a mental health condition in any given year¹. Mental health affects us all, and its critical that we move beyond awareness to take meaningful steps for our well-being and that of our community.May 2025Important Notices
Special notice: Important policy changes
Effective June 1, 2025, UPMC Health Plan will be implementing policy changes that will require providers to obtain prior authorizations for services listed in the following policies. For more information, please visit upmchp.us/policiesandprocedures.May 2025Important Notices