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ACA Risk Adjustment Claims Submission Announcement

UPMC Health Plan·Provider Announcement
Effective date
Not stated
We identified it
Aug 7, 2026
Days to comply
—

Summary

UPMC Health Plan requires all network providers to submit outstanding CY 2024 ACA claims (Platinum, Gold, Silver, Bronze plans) by April 1, 2025, to meet the HHS EDGE server submission deadline of April 30, 2025. Claims adjudicated after April 1 will not be included in risk adjustment data submission.

Action Required

Action needed
By April 1, 2025: Billing team must identify and submit all outstanding CY 2024 claims for UPMC ACA members through Provider OnLine at upmchealthplan.com/providers/medical. Verify claims for all plan types (Platinum, Gold, Silver, Bronze) are processed and adjudicated before this deadline. Contact Provider Services or physician account executive with any submission questions. Claims adjudicated after April 1, 2025 will be excluded from EDGE risk adjustment data and may impact future plan ratings and reimbursement models.

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