CommercialPrior AuthHigh impact
Important announcement: UPMC Health Plan retires MP.PA.147
UPMC Health Plan·Gastroenterology, Internal Medicine, Family Medicine·Prior Authorization
Effective date
Jan 8, 2025
We identified it
Aug 7, 2026
Summary
UPMC Health Plan has permanently retired policy MP.PA.147 for diagnostic and surveillance colonoscopy in adults 18+. Prior authorization is no longer required for these procedures. Any previously submitted authorization requests are voided, and patient care should proceed without delay.
Action Required
Immediately: Billing team must remove prior authorization requirements for diagnostic and surveillance colonoscopy procedures from all UPMC Health Plan workflows and billing system rules. Update encounter forms, scheduling templates, and authorization checklists to reflect that no prior auth is needed for these procedures. Notify clinical staff that this policy is retired and authorization is not required. For any pending authorization requests already submitted, confirm they are voided and do not wait for approval before processing claims. Providers remain responsible for clinical decisions and billing; authorization voidance does not guarantee payment. Contact UPMC Provider Services at 1-866-918-1595 with questions.