CommercialPrior AuthHigh impact
Clinical documentation required for medical policy prior authorizations
UPMC Health Plan·Oncology, Radiology, General Surgery +4 more·Prior Authorization
Effective date
Jun 26, 2026
We identified it
Jun 20, 2026
Summary
UPMC Health Plan now requires clinical documentation to be uploaded during online prior authorization submissions for six specific procedure categories including radiation therapy, laparoscopic cholecystectomy, sleep studies, spinal decompression, and cardiac devices. Starting June 26, 2026, their system will verify documentation is submitted before approving authorizations.
Action Required
By June 26, 2026: Staff must update prior authorization workflow to upload all supporting clinical documentation during online submission through Provider OnLine website for MP PA 142 (EBRT), MP.PA.143 (SRS/SBRT), MP PA 146 (Laparoscopic cholecystectomy), MP.PA.144 (Sleep Studies), MP.PA.135 (Lumbar Spinal decompression), and MP.PA.137 (Cardiac Devices). Train authorization staff to use Auth Entry/Inquiry portal and upload documentation during submission process. Failure to submit documentation will result in delays or denials.