ExchangeAdministrativeMedium impact
ACA Risk Adjustment Claims Submission Announcement
UPMC Health Plan·Provider Announcement
Effective date
Apr 1, 2026
We identified it
Jun 20, 2026
Summary
Healthcare providers must submit all outstanding 2025 calendar year claims for ACA marketplace members (Platinum, Gold, Silver, and Bronze plans) by April 1, 2026. Claims submitted after this deadline will not be included in the required federal EDGE data submission, which could impact risk adjustment calculations.
Action Required
By April 1, 2026: Billing team must submit all outstanding calendar year 2025 claims for ACA marketplace members (Platinum, Gold, Silver, and Bronze plans) through Provider OnLine at upmchealthplan.com/providers/medical. Set up tracking system to identify and prioritize ACA claims from 2025. Claims submitted after deadline will not be included in federal EDGE data submission for risk adjustment.