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
Medicaid Renewal
Starting in 2027, some Medicaid recipients (ages 19–-64) will have new requirements to keep their coverage.Aug. 2026Important Notices
Provider Directory Updates and Required Attestation
As you know, UPMC Health Plan requires all providers to verify their provider directory information at least every 90 days (quarterly).Aug. 2026Important Notices
Voluntary nationwide recall: Tyenne (Fresenius – August 2026)
Fresenius Kabi is recalling one lot, lot 16UI07, of Tyenne® (tocilizumab-aazg) Injection 400 mg/20 mL (20 mg/mL) 20 mL vials. Tyenne is used for the treatment of certain arthritis conditions.Aug. 2026Pharmacy Updates