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Important notice: Appendix A – COVID-19 Special Coverage Payment Policy will expire soon
UPMC Health Plan·Reimbursement
Effective date
Sep 30, 2024
We identified it
Aug 7, 2026
Summary
UPMC Health Plan is retiring Appendix A – COVID-19 Special Coverage and Payment Policy effective September 30, 2024. All special coverage and payment policies related to the COVID-19 public health emergency will expire on this date. Billing teams must identify which COVID-19 specific billing practices, codes, and payment exceptions currently in use will no longer be valid after this date and transition to standard reimbursement procedures.
Action Required
By September 30, 2024: Billing team must complete the following: (1) Review current Appendix A – COVID-19 Special Coverage and Payment Policy at upmchp.us/policiesandprocedures to identify all COVID-19 specific billing codes, payment rates, and coverage exceptions currently being applied; (2) Audit active claims and workflows to identify which COVID-19 special policies are being used; (3) Update billing system rules, fee schedules, and claim edits to remove all COVID-19 special coverage exceptions and revert to standard UPMC Health Plan reimbursement policies; (4) Update provider encounter forms, templates, and documentation requirements to reflect standard (non-COVID) billing procedures; (5) Communicate changes to all providers and front desk staff. After September 30, 2024, claims submitted under expired COVID-19 special coverage policies will be subject to standard coverage limitations and may be denied or require rebilling under appropriate standard codes. Contact UPMC Health Plan Provider Services at 1-866-918-1595 with questions.