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Enhanced claim editing effective July 1
UPMC Health Plan·Provider Announcement
Effective date
Jul 1, 2024
We identified it
Jun 20, 2026
Summary
UPMC Health Plan is implementing enhanced claim editing programs starting July 1, 2024, that will expand automated claim reviews based on AMA CPT guidelines, Medicare policies, and Medicaid guidelines. This will likely result in more claim denials for incorrect coding and billing practices.
Action Required
By July 1, 2024: Billing team must review and ensure compliance with AMA CPT coding guidelines, Medicare policies, and Medicaid guidelines to prevent claim denials. Monitor upmchp.us/claimsediting for additional resources and documentation over the coming months. Review all claim denials on EOPs and electronic remittances for new editing concepts and adjust billing practices accordingly.