What types of policy changes does UPMC Health Plan issue?

UPMC Health Plan regularly publishes coverage updates including prior authorization requirement changes, billing code additions or deletions, plan-type coverage modifications, and clinical policy revisions. PolicyChanges.app monitors these notices and summarizes the impact for providers.

How often does UPMC Health Plan update its policies?

UPMC Health Plan typically releases policy bulletins on a rolling basis throughout the year. Our system checks for new updates daily and adds them to this feed as soon as they are identified.

How many UPMC Health Plan policy changes are tracked here?

This page currently tracks 50 documented UPMC Health Plan policy changes. New items are added as they are identified.

What should I do when UPMC Health Plan changes a prior authorization policy?

Review each change's effective date and action-required notes. Update your billing and clinical workflows before the effective date to avoid claim denials. Each policy detail page on PolicyChanges.app includes a plain-English summary and action items.

UPMC Health Plan Policy Changes 2026 | Prior Auth & Coverage Updates

UPMC Health Plan Policy Changes & Prior Auth Updates

We track 50 documented policy changes from UPMC Health Plan across MD, NY, PA. Each entry includes an AI-generated plain-English summary, effective date, affected billing codes, and a direct link to the original UPMC Health Plan notice. Use the related links below to narrow results by specialty or state, or sign up for a free daily alert to receive new UPMC Health Plan updates automatically.

Medium impact

IMPORTANT UPDATE: Extending the current UPMC Health Plan utilization model for selected MSK, cardiology, and radiology codes

UPMC Health Plan·Identified Jun 20, 2026

UPMC Health Plan is extending their current utilization model through March 1st for MSK, cardiology, and radiology procedures previously managed by HealthHelp. Prior authorization requests must still be submitted for claims to be paid, but they will be auto-approved without clinical documentation review until the March 1st deadline.

Updated blood lead reference value for children

UPMC Health Plan recommends COVID-19 booster shots for all who are eligible

Requirements under the No Surprises Act

Recall: Nitroglycerin Spray

New CME webinar on quality measures available

COVID-19 vaccines; No cost share for members

CME webinar: Pediatric Oral First Aid

CME webinar: Behavioral Health in Primary Care: How UPMC Health Plan Can Help

Recall: Clobetasol

Medicare annual wellness visit (AWV) reimbursement rate change 2022

Webinar: Pediatric Dyslipidemias: Screening, Diagnosis, and Management in the Primary Care Setting (recorded live)

Recall: Metformin ER

IMPORTANT UPDATE: Extending the current UPMC Health Plan utilization model for selected MSK, cardiology, and radiology codes

CME webinar: Addiction Care for the Non-Addiction Provider Part 4 – Overview of Management and Available Resources

Recall: Semglee

Webinar: Pediatric Behavioral Health; Best Practices for Primary Care (recorded live)

New requirements for physician extenders

Important update: InterQual Connect Prior Authorizations

COVID-19 vaccine booster updates

Recall: Accupril Tablets

Home health telehealth update

Promote the UPMC Pathways for Students Career Fair

UPMC Health Plan achieves high marks in provider satisfaction

UPMC for You is expanding across Pennsylvania in September!

Recall: Anagrelide

Recall: Morphine Sulfate

Recall: Insulin Glargine

CME webinar: Pediatric Asthma Management Guidelines

MC Health Plan achieves high ratings in provider satisfaction

Recall: Zelnorm

Recall: Milk of Magnesia

Earn the UPMC LGBTQIA+ Affirming Provider designation!

COVID-19 vaccines for children

Recall: Magnesium Citrate

UPMC for You has been awarded a Medicaid Managed Care Contract for all five Physical HealthChoices zones across the Commonwealth of Pennsylvania

UPMC Health Plan achieves high ratings in provider satisfaction

Recall: Magnesium Citrate

New 988 Suicide and Crisis Lifeline Offers Pennsylvanians Easy Access to Mental Health Crisis Support 24/7

CME webinar series: Addiction Care for the Non-Addiction Provider

CME webinar: Screening and Assessment for Suicide Prevention

Earn the UPMC LGBTQIA+ Affirming Provider designation!

Medicaid implementation/Member enrollment reminder

Cotiviti collaboration aims to prevent payment errors and improve the reimbursement process

CME Webinar: Pediatric Collaborative Call—Addressing Health Disparities: Impact on Maternal and Pediatric Health

Thank you for helping UPMC for Life earn an excellent 5 out of 5 stars AGAIN

Mandatory Training for Medicare SNP Providers

Pennsylvania DOH issues poliovirus health advisory and recommendations

CME webinar: 988 Suicide and Crisis Lifeline (recorded)

Recall: Quinapril-Hctz

Heart catheter authorization update