WEBUPMC Health Plan requires a prior authorization request for specific procedures or treatments to determine whether coverage of a request will be approved or denied. Providers may submit a request for prior authorization to the Clinical Operations/Utilization Management Department, including supporting documentation …
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Pharmacy Prior Authorization | Providers | UPMC Health Plan
WEBProviders may submit prior authorization requests to UPMC Health Plan online or by fax. To submit a request online, please visit UPMC's PromptPA Portal. To submit a request via fax, please select the appropriate form below. These forms serve all UPMC Health Plan products unless specified otherwise.
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Documents and Forms | UPMC for Life - UPMC Health Plan
WEBApply Online. Enroll In Person. Enroll By Phone. Our members can digitally access important documents and forms. View the latest UPMC for Life plan benefit materials, forms, and directories here.
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Forms for Health Care Providers | UPMC Health Plan
WEBMedical. Dental. Vision. HCBS. MEDICAL PROVIDER FORMS. Get fast, easy access to downloadable forms. Medical Providers. Medical Prior Authorization. Download medical prior authorization forms here. Find Medical Prior Authorization Forms. Pharmacy Prior Authorization. Download pharmacy prior authorization forms here.
WEBFor Prescription Drugs: Name of drug/medication. Strength of the drug (example 5 mg) Quantity being prescribed. Days supply. New Prior Authorization. Check Status. Member. Prescriber.
WEBOur prior authorization, eligibility status, claims processing, and claims payment processes are fully operational, and UPMC Health Plan’s provider portal, Provider OnLine, is fully functional and available. Providers can continue to submit claims, check eligibility and benefits, and request prior authorization through Provider OnLine without ...
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Policies & Procedures Manual | Health Care Providers - UPMC Health Plan
WEB*Medical policies require prior authorization from our Medical Management Department. Submit prior authorizations via Provider OnLine. If you have any questions, contact Medical Management at 1-800-425-7800. You can view upcoming changes to medical policies at upmchp.us/ProviderRLDocs.
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Information & Resources | For Health Care Providers - UPMC Health Plan
WEBAccess downloadable forms including those for Medical Prior Authorization and Pharmacy Prior Authorization. View Forms. Other Information. Find all other provider information here including Pharmacy Resources, Patient Health, and the Quality Partners incentive program. Find All Other Provider Information.
WEBThere are two ways to access your member guide: UPMC Health Plan app: Sign in and follow this path: Plan Details > Member Guide. MyHealth OnLine: Sign in and follow this path: Your Insurance > Plans and Coverage > Member Guide.
WEBAs a provider-led health plan, we’ve created a unique laboratory to align incentives, deliver better care, and improve the health of our members. Read about our latest innovations that control costs and improve health outcomes. UPMC Health Plan offers access to the best hospitals, best doctors, and best customer service for individuals ...