ACA Risk Adjustment Claims Submission Announcement
Jan. 2026Important Notices
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.
Recent Announcements
Clinical workflow changes through Epic®
Changes are coming for network providers that utilize Provider OnLine to submit specific information to UPMC Health Plan. Select activities that were previously completed in Provider OnLine will now transition to UPMC Health Plan Tapestry Link.Sep. 2026Important Notices
CME Webinar: Lifestyle Medicine in Practice: Evidence‑Based Strategies for Chronic Disease Care
Please join us for a live, CME-accredited webinar on Wednesday, Sept. 23 from noon to 1 p.m., that will provide an overview on lifestyle medicine. Participants will learn how to integrate six core domains—nutrition, physical activity, sleep, stress management, avoidance of risky substances, and social connection—into routine care using practical tools such as brief counseling, motivational interviewing, and team-based strategies.Sep. 2026Education/Webinars
Voluntary nationwide recall: Thyroid (Vitruvias – August 2026)
Vitruvias Therapeutics Inc. is recalling one lot, lot 504950, of Thyroid Tablets, USP 30 mg. Thyroid Tablet is used to treat hypothyroidism (underactive thyroid).Sep. 2026Pharmacy Updates