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The importance of PRD forms for complex patients and staying updated on changes
UPMC Health Plan·Pediatrics·Provider Announcement
Effective date
Jan 8, 2025
We identified it
Aug 7, 2026
Summary
UPMC Health Plan is emphasizing the critical importance of Personal Representative Designation (PRD) forms for patient care, particularly for complex patients. Effective immediately, parents/guardians cannot discuss health information or file grievances for patients age 13+ without a PRD on file, and a new PRD must be completed when the patient reaches age 18. Billing teams must ensure PRD forms are obtained and documented before processing claims or handling grievances.
Action Required
Immediately: (1) Front desk/intake staff must verify PRD form status at all patient encounters, with special attention to patients age 13 and older. (2) For patients age 18 and older, confirm a valid PRD is on file before allowing parents/guardians to access health information, authorize treatment, or file grievances. (3) For patients age 13-17, obtain PRD forms from parents/guardians if not already on file. (4) Billing team must flag claims where parent/guardian involvement is required but no PRD is documented—do not process claims or accept grievances without PRD confirmation. (5) Update patient intake forms to prompt for PRD completion and make it a required field before claim submission. (6) Direct parents/guardians to complete PRD forms (available at upmchealthplan.com/providers/medical under Medical Prior Authorization and Physician Forms section) and create member accounts on UPMC Health Plan member portal. Consequences of inaction: Claims may be denied if parent/guardian authorization is required but no PRD exists; grievances cannot be filed by parents/guardians without a PRD on file; compliance risks increase for pediatric care transitions.