MedicaidCoverageMedium impact
Certified Community Health Worker (CCHW) Provider Billing Notification
UPMC Health Plan·PA·Reimbursement
We identified it
Aug 7, 2026
Summary
UPMC for You (Medicaid) will now reimburse for up to three Certified Community Health Worker (CCHW) visits per member per calendar year for Pennsylvania Medicaid recipients. CCHWs must be enrolled in the Medical Assistance program and documented as the rendering provider on claims. This benefit does not apply to Community HealthChoices participants.
Action Required
Immediately: Billing team must (1) Verify that any CCHWs providing services are enrolled in the Pennsylvania Medical Assistance program; (2) Update billing software and claims submission processes to identify and track CCHW visits, capping reimbursement at 3 visits per member per calendar year; (3) Ensure claims documentation includes the CCHW as the rendering/servicing provider; (4) Refer to UPMC Health Plan's Billing Guide for applicable billing codes and specifications; (5) Train billing and administrative staff to distinguish between eligible Medicaid members and Community HealthChoices participants (ineligible for benefit). Failure to comply with visit limits and provider enrollment requirements will result in claim denials or recoupments.