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
CME Webinar: Getting it Right from the Start: Identifying Patient Advanced Care Directives
Please join us for a live, CME-accredited webinar on Thursday, Oct. 15, 2026 that will educate providers on identifying advanced directives and surrogate decision makers on admission.Oct. 2026Education/Webinars
UPMC Health Plan Tapestry Link live training session
UPMC Health Plan Tapestry Link is scheduled to go live on Tuesday, Dec. 1, 2026. To help prepare you for this launch we will be hosting a live training session on Wednesday, Nov. 4, 2026, from noon to 1 p.m. to help you familiarize yourself with the platform. During this training we will discuss:Sep. 2026Education/Webinars
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