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Provider Telehealth Guidelines

UPMC Health Plan believes telehealth is an important care delivery option that helps members gain access to care. We are committed to offering industry-leading coverage to our members—subject to federal, state, and local regulations—and to support our network providers in delivering cost-effective, quality care.

Telehealth benefits are available to members of all lines of business. Services may be reimbursed to providers who adhere to the telehealth pay policy, MP.148, and provide treatment that is in line with their scope of practice.

COVID-19 materials

Clicking some of the links provided will redirect you to landing pages outside the UPMC Health Plan website that provide content we do not monitor and for which we are not responsible.

While almost all of our individual and group plans include extensive telehealth benefits, some ASO/self-funded employer plans do not cover telehealth services.

Considering Telehealth

  • Consider conducting a needs assessment

    Before deciding to offer telehealth care from your practice, you should evaluate whether the model fits your patients’ needs and would work with the type of care you provide.

    Consider the following questions:

    • Do your patients want telehealth services?
      • A recent survey showed that the demand for telehealth care is on the rise:
        • Prior to the COVID-19 pandemic, 66 percent of people were open to having a telehealth visit prior to the pandemic and only 8 percent had used telehealth.1
        • Since COVID-19, surveys have shown that 71 percent are now open to having a telehealth visit and over 50 percent had done so in the three months prior to the survey.1
        • 83 percent of respondents said they plan to continue using telehealth even after the coronavirus threat is mitigated.
      • If you’re not sure, try conducting a survey of your patients in your office or via email.

    • Are the visit types you conduct conducive to a telehealth visit?

    • Are other providers offering similar telemedicine services?
      • If so, can you collaborate or share best practices?
  • Map out the use case

    If you’ve decided that offering telehealth services is right for you, consider how your process would work by following these steps:

    • Map out what your current visit looks like for the visit types identified in section 1.
    • Determine if any parts of that process currently use in-person services.
    • Determine which of the above-identified aspects can be replaced with comparable care via telehealth and note what that replacement would look like.
    • Map out a new process that incorporates the new, telehealth-compatible replacements.
    • Identify if any of your identified processes will change.
    • Work with frontline staff on how the processes can be adjusted.
  • Pick a platform

    In order to conduct telehealth visits, you must use a platform that meets certain requirements. There may also be other, optional features you want to use:

    • Be sure to confirm that the platform is HIPAA compliant.
      • When using telehealth technologies and systems to render services, providers must consider security, patient confidentiality, and privacy. You are required to use a HIPAA-compliant, secured, platform for the purpose of telemedicine encounters. The electronic channel must include and support all of the following:
        • Access controls
        • Encryption and decryption
        • Audit controls
        • Transmission security
        • Third-party storage considerations, including a business associate agreement
        • HIPAA technical safeguards
        • Payment card industry data security standard (PCI-DSS)

    • Make considerations for your capability needs
      • Do you want your patients to be able to self-schedule?
      • Do you need your platform to integrate with your EMR?
        • For example, do you want:
          • Video feature built in to EMR?
          • HL7 and MDM messaging?
      • What data reporting capabilities does the vendor offer?
  • Ensure broadband requirements are met

    Please refer to the Overcoming barriers section below.

  • Hardware considerations

    What physical components will you need to incorporate telehealth into your practice? Consider the following:

    • Do you prefer traditional computers or smart devices, such as tablets or smartphones?
    • How many providers will be conducting telehealth visits?
      • This will determine the number of hardware devices to make available.
    • Will providers be conducting the video visit on one platform and documenting in another platform?
      • This will determine if the provider needs two monitors.
    • Do the preferred devices come with cameras or will you need to buy them separately?
  • Video visit aesthetics considerations

    Telehealth visits are not the same as a regular video chat. They must maintain a level of professionalism akin to that of an in-office visit. Consider:

    • Visit privacy.
    • Noise level.
    • Visual distractions.
    • The provider’s clothing.
    • Lighting in the room.
    • How to maintain eye contact.
  • Consent documents

    You can find more information about consent by visiting the Current State Laws & Reimbursement Policies website and selecting the state in which you practice.

  • Consider costs
    • What costs are incurred or reduced by changing the workflow? (Refer to section 2.)
    • How much will hardware cost? (Refer to section 5.)
    • What will reimbursement look like?
      • This is different for every payer. Please refer to the telehealth policy section of this page for UPMC Health Plan’s policies.
    • Understand coding and billing requirements. Please refer to the telehealth and billing section of this page for UPMC Health Plan’s policies.
  • Review state and federal laws

    Please check the federal and state laws that are applicable to your practice. The National Telehealth Policy Resource Center monitors telehealth legislation and may be a helpful resource on the laws that apply to your practice. Visit to learn more.

1Heath S. 83% of patients predict long-term telehealth care access. Patient Engagement HIT. June 18, 2020. Accessed November 12, 2020. Back to Top ↑

Getting started

What is telehealth?

Telehealth is the use of electronic information and communication technologies to provide and support health care. It can include interactive communication between a patient and provider or an interprofessional consultation between two providers.

Telehealth can take place in real-time between two individuals, or it can be “asynchronous”—where secure messages are exchanged without real-time interaction an example would be confirming a diagnosis or establish a treatment plan, etc.

Benefits of telehealth

Using telehealth to care for your patients may offer many benefits, including:

  • Patient satisfaction.
    • Can help create better relationships with your patients
    • Increases patient retention
  • Convenience.
    • Patients are more likely to show up and be on time for scheduled appointments
    • Patients are less likely to cancel appointments due to inclement weather, lack of child/elder care, transportation issues, etc.
  • Improved access.
    • Captures more patients in remote locations
    • Patients who have difficult work schedules can be seen on a break or lunch break
    • Increased visit compliance for patients with chronic conditions
  • Improved quality.
    • Accommodates same-day appointments for urgent care issues
    • Patients can recover and heal at home without having to attend an on-site office visit where they may be exposed to other illnesses
  • Decreased provider fatigue/burnout.
    • Allows you to see more patients in less time
    • Better work-life balance through flexible scheduling
Types of technology

In order to provide telehealth services to your patients, you will need internet access and a device, such as a laptop with a webcam, smartphone, or tablet. Some services are also available via phone.

During the public health emergency, there may be some exceptions for use of technology that is not in compliance with HIPAA regulations. However, providers are strongly encouraged to use a secure technology that is HIPAA compliant whenever able to do so.

  • Care delivery options
    • Live (synchronous) videoconferencing
      • Video visits in real-time with your patients
    • Store-and-forward (asynchronous)
      • The transmission of recorded health history to a care provider, usually a specialist. Typically, data is gathered from the patient and sent through a secure email or messaging service to a cloud-based platform. The data is analyzed, and a diagnosis and treatment plan are sent back to the patient or provider. It is sometimes referred to as an e-visit.
    • Remote patient monitoring (RPM
      • The use of connected electronic tools to record personal health and medical data in one location for review by a provider in another location, usually at a different time.
    • Phone
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Preparing your patients for telehealth

  • Inform your patients that you are offering telehealth via:
    • Website updates.
    • Email blasts.
    • Letters/Postcards to their homes.
    • Phone calls to patients with scheduled appointments.
  • Inform your patients which conditions your office will treat via telehealth.
  • Prepare your patients for their visit.
    • Let them know:
      • How you will connect (e.g., phone, video, messaging).
      • If they will need to download an app (e.g., AmWell, MyUPMC).
      • What to do if they need to troubleshoot.
      • What to wear.
      • If they need to take any vitals prior to their appointment.
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Telehealth FAQ

During the COVID-19 public health emergency we have made significant expansions to our telehealth coverage, including greater allowance for use of telephone-based visits, to make telehealth more accessible for both patients and providers.

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Telehealth gaps in care tip sheets

When speaking with your patients during telehealth encounters, following these tips may assist in gap closure.

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Policy/Billing and coding/reimbursement

Provider is responsible for the appropriate billing of services

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Annual wellness visit (AWV) via telehealth

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Well-child visit via telehealth

Learn more about telehealth well-child visits:

Provider is responsible for all clinical decisions and appropriate billing of services.

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Video visit checklist (clinical etiquette – from AMA)

  • Ensure privacy (HIPAA)
  • Clinically appropriate exam room location, size, and layout
  • Avoid background noise
  • Adequate lighting for clinical assessment
  • Desktop computer vs. tablet
  • High-speed internet
  • Web camera
  • Microphone
  • Dual screens for EHR documentation note-taking
  • RPM dashboard (if using)
  • Headphones
  • The same level of professional attire as in-person care
  • Turn off other web applications and all notifications
  • Review patient complaints and records before beginning call
  • Adjust webcam to eye level to ensure contact
  • Narrate actions with patient (If you need to turn away, look down to take notes, etc.)
  • Verbalize and clarify next steps, such as follow-up appointments, care plan, prescription orders
  • Pause to allow transmission delay
  • Speak clearly and deliberately
  • Choose empathetic language
  • Use nonverbal language to signal that you are listening
Additional things to consider during a visit
  • Skin tone of the patient
  • Eye redness
  • Work of breathing
  • Ask your patient to point to "where it hurts"
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Cultural sensitivity

  • Cultural sensitivity is significant when administering telehealth similar to in-person visits because it allows us to effectively function in other cultures, allows us to respect and value other cultures, and can reduce barriers between professionals and their patients.
    • Telemedicine communication must be respectful of the patient’s language, cultural beliefs, and health literacy level.
  • Telehealth increases access to care in underserved communities and can bridge cultural gaps.
  • See patients in their relaxed, natural state and how they live.
  • Things to consider:
    • Not all patients may have Wi-Fi access.
    • There may only be one, shared device in the home.
    • Patients may have prepaid minutes or no mobile coverage.
    • Space and/or quiet rooms may not be a possibility for all patients.
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Overcoming barriers

Top barriers to adoption:

  • Broadband issues
  • Reimbursement
  • Licensing
  • Health information exchanges
  • Insurance parity and malpractice coverage

    Many of these barriers have been lifted during the COVID-19 pandemic.

    • UPMC Health Plan will reimburse telehealth services provided to our members at the full, contracted rate for in-person services.
    • Providers may temporarily be able to practice across state lines.

Recommendations for overcoming above barriers:

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Becoming designated as a telehealth provider in the UPMC Health Plan Provider Directory

UPMC Health Plan members can search our provider directory for providers who offer some services via telehealth. Providers who offer telehealth are encouraged to sign up to be featured in this directory. Being included in the directory does not require providers to offer all services via telehealth or offer telehealth services to all patients; providers must determine what is medically appropriate. Please contact your physician account executive if you are interested in appearing as a telehealth provider in our searchable directory.

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UPMC AnywhereCare

As UPMC Health Plan members, your patients have 24/7 access to health care providers for non-emergent issues with the UPMC AnywhereCare app. This means you can feel comfortable knowing your patients are in good hands. Patients have the ability to have a visit summary sent to their PCP.

Conditions treated include:

  • Bronchitis and cough.
  • Cold and flu symptoms.
  • Diarrhea.
  • Pink eye.
  • Rash.
  • Seasonal allergies.
  • Sinus infection.
  • Tick bites.
  • Urinary tract infection.
  • Vaginal yeast infection.
  • General medical advice.
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UPMC VirtualCare

UPMC Health Plan is excited to announce a new, innovative product offered through the UPMC Health Plan Marketplace and Pennie™ for coverage starting Jan. 1, 2022. UPMC VirtualCare offers low-cost care options and choice to see providers virtually or in person.

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