CommercialPrior AuthHigh impact
Clinical documentation required for hip, knee, and shoulder prior authorizations
UPMC Health Plan·Orthopedics, Sports Medicine·Prior Authorization
Effective date
Jul 24, 2025
We identified it
Jun 20, 2026
Summary
UPMC Health Plan now requires clinical documentation to be uploaded during online prior authorization submissions for hip, knee, and shoulder procedures. The system will enforce this requirement starting July 24, 2025, and authorizations will not be provided without the supporting documentation.
Action Required
Before July 24, 2025: Staff must update prior authorization workflow to upload all supporting clinical documentation during online submission process for hip, knee, and shoulder procedures through UPMC's Provider OnLine website. Train staff on new upload requirements during auth entry/inquiry process. Failure to submit documentation will result in authorization delays or denials.