ExchangeAdministrativeHigh impact
ACA Risk Adjustment Claims Submission Announcement
UPMC Health Plan·Provider Announcement
Effective date
Apr 1, 2025
We identified it
Jun 20, 2026
Summary
UPMC Health Plan requires all network providers to submit outstanding 2024 claims for ACA members (all metal tier plans) by April 1, 2025. Claims submitted after this deadline will not be included in required federal EDGE server data submission.
Action Required
By April 1, 2025: Billing team must submit ALL outstanding calendar year 2024 claims for ACA members enrolled in Platinum, Gold, Silver, and Bronze plans through Provider OnLine at upmchealthplan.com/providers/medical. Review open claims report and prioritize ACA member claims. Claims not submitted by deadline will be excluded from federal risk adjustment reporting.