CommercialPrior AuthHigh impact
Important update: InterQual Connect Prior Authorizations
UPMC Health Plan·PA · Cardiology, Radiology, Diagnostic Imaging·Prior Authorization
Effective date
Mar 1, 2022
We identified it
Jun 20, 2026
Summary
UPMC Health Plan is resuming formal clinical reviews for prior authorizations on imaging and cardiology procedures starting March 1, 2022, after previously being managed by Health Help. Complete documentation must be submitted with prior auth requests to increase auto-approval chances and avoid manual review delays.
Action Required
By March 1, 2022: Billing and prior authorization staff must resume submitting complete prior authorization requests for all imaging and cardiology procedures to UPMC Health Plan's InterQual Connect system. Ensure all clinical documentation, medical necessity justification, and required forms are complete before submission to maximize auto-approval likelihood. Incomplete submissions will face manual review delays and potential denials.