ACA Risk Adjustment Claims Submission Announcement

Notice: Submit your claims for ACA members

This is a reminder that all network providers must submit outstanding calendar year (CY) 2025 claims for ACA members (Platinum, Gold, Silver, and Bronze plans) no later than April 1, 2026. The U.S. Department of Health and Human Services requires issuers to submit their CY claims to the EDGE server by April 30 every year to provide a complete and accurate picture of each patient’s health status.

Claims adjudicated after the deadline will not be included for EDGE data submission.

You can submit claims through Provider OnLine at upmchealthplan.com/providers/medical. If you have any questions about this matter, please contact Provider Services or your physician account executive.