Medicare AdvantageCoverageHigh impact
What providers need to know about charging UPMC <em>for Life</em> Complete Care members cost sharing
UPMC Health Plan·Provider Announcement
We identified it
Aug 7, 2026
Summary
UPMC for Life Complete Care (HMO D-SNP) has implemented new grace period rules effective with the new year that change which members can be charged cost sharing. Billing teams must understand eligibility criteria for cost sharing collection to avoid billing errors and claim denials. The policy outlines specific exceptions and rules for determining member cost-sharing responsibility.
Action Required
Immediately: Billing team must review and understand the new UPMC for Life Complete Care grace period rules at the provided URL (https://www.upmchealthplan.com/providers/medical/announcements-updates/announcements/2024-announcements/03-07-what-providers-need-to-know-about-charging-upmc-for-life-complete-care-members-cost-sharing). Before the next UPMC for Life Complete Care patient encounter: (1) Update billing system logic to apply new grace period eligibility rules before charging cost sharing; (2) Train front desk and billing staff on new member eligibility criteria; (3) Audit recent claims to identify any incorrectly charged cost sharing under old grace period rules and submit corrections. Document which members qualify for cost sharing under exceptions. Failure to apply correct grace period rules will result in claim denials and patient billing disputes.