MedicaidAdministrativeMedium impact
Continuous coverage unwinding
UPMC Health Plan·PA·Provider Announcement
Effective date
Apr 1, 2023
We identified it
Aug 7, 2026
Summary
UPMC has released educational materials and guidance for the Medicaid continuous coverage unwinding period that began April 1. This policy affects patient eligibility determinations and coverage terminations. The billing team should be aware that Medicaid patients may experience coverage gaps or terminations during this unwinding process, requiring verification of active coverage before claim submission.
Action Required
Immediately: Billing team must verify Medicaid eligibility for all UPMC for You and UPMC Community HealthChoices patients BEFORE claim submission during the continuous coverage unwinding period (April 1 onwards). Front desk staff should alert patients to monitor mail from DHS regarding renewal requirements and coverage termination notices. Implement a pre-claim eligibility check process in the billing system to catch patients with terminated or pending coverage. Contact Provider Services at 1-866-918-1595 if questions arise about patient coverage status. Failure to verify active coverage may result in claim denials for terminated or lapsed Medicaid beneficiaries.