CommercialPrior AuthMedium impact
IMPORTANT UPDATE: Extending the current UPMC Health Plan utilization model for selected MSK, cardiology, and radiology codes
UPMC Health Plan·Orthopedics, PM&R (Physical Medicine & Rehab), Cardiology +2 more·Prior Authorization
We identified it
Jun 20, 2026
Summary
UPMC Health Plan is extending their current utilization model through March 1st for MSK, cardiology, and radiology procedures previously managed by HealthHelp. Prior authorization requests must still be submitted for claims to be paid, but they will be auto-approved without clinical documentation review until the March 1st deadline.
Action Required
Before March 1st: Continue submitting prior authorization requests for all MSK, cardiology, and radiology procedures previously requiring HealthHelp authorization. Billing team must ensure all prior auth requests include complete information to qualify for auto-approval. After March 1st, expect return to full clinical documentation review process.