CommercialAdministrativeHigh impact
Important update: UPMC Health Plan 835 readmits
UPMC Health Plan·Reimbursement
Effective date
May 7, 2024
We identified it
Aug 7, 2026
Summary
UPMC Health Plan discovered a systems issue affecting Electronic Remittance Advice (835) data created between April 26 and May 7, 2024. The issue has been rolled back as of May 7 at 3 p.m., and all 835s created after that time are now correct. Billing teams should reconcile any discrepancies in 835 data from the affected period and await UPMC's formal count of impacted providers and claims.
Action Required
By May 15, 2024: Billing team must review all Electronic Remittance Advice (835) documents received from UPMC Health Plan created between April 26 and May 7, 2024 for potential data errors. Cross-reference affected 835s against Explanations of Payment (EOPs) and Explanations of Benefits (EOBs) to identify discrepancies, as those documents were not affected by the systems issue. Flag any claim reimbursement or adjudication discrepancies for manual review. Contact UPMC Provider Services at 1-866-918-1595 or your physician account executive to report discrepancies and obtain the formal list of impacted claims when UPMC releases it (expected within one week of May 8, 2024). Verify that all 835s created on or after May 7 at 3 p.m. are processing correctly going forward. Do not process payments or close accounts based on potentially erroneous 835 data from the affected date range until verification is complete.