Medicare AdvantagePrior AuthMedium impact
Important Notice Regarding Prior Authorizations for MP.PA.147
UPMC Health Plan·Gastroenterology, Internal Medicine, General Practice·Prior Authorization
Effective date
Jul 1, 2025
We identified it
Aug 7, 2026
Summary
UPMC Health Plan is pausing prior authorization requirements for diagnostic and surveillance colonoscopies (MP.PA.147) from now until September 1, 2025. Previously submitted authorizations will be processed without review. Billing teams should continue normal operations without PA holds, but note that authorization is not a guarantee of payment.
Action Required
By September 1, 2025: Billing team must prepare to resume prior authorization requirements for MP.PA.147 (diagnostic and surveillance colonoscopies, age 18+). Immediately: Update internal workflows to reflect that prior authorizations are NOT required for colonoscopy claims under UPMC Health Plan during the pause period (July 1 - August 31, 2025). Instruct front desk and clinical staff that patient care should not be delayed pending authorization. Ensure billing software does not hold or deny colonoscopy claims for missing prior auth during this window. Prepare provider communications for September 1, 2025 reactivation of PA requirements. Document all submitted authorizations—these will be entered without review per UPMC guidance.