MedicaidAdministrativeMedium impact
UPMC for You is expanding across Pennsylvania in September!
UPMC Health Plan·PA·Provider Announcement
Effective date
Sep 1, 2022
We identified it
Aug 7, 2026
Summary
UPMC for You Medicaid Managed Care has expanded to serve all five Pennsylvania HealthChoices zones effective September 1, 2022, including new coverage in the Northeast and Southeast zones. Medicaid patients will receive notification letters from PA-DHS, and providers should expect a toolkit with value-added benefits information and office materials. No immediate billing code or prior authorization changes are specified.
Action Required
By June 22, 2022: Billing and front-desk staff should prepare to receive and review the UPMC for You provider toolkit when it arrives in the mail. Ensure office staff can answer patient questions about the Medicaid managed care expansion. Update patient records and systems to reflect UPMC for You as the applicable MCO for Northeast and Southeast Pennsylvania patients effective Sept. 1, 2022. Verify that all Medicaid claims for affected patients in these new zones are submitted to UPMC for You after the go-live date. Review the provider FAQ at upmchp.us/ProviderFAQ to understand value-added benefits and any network changes. Note: Implementation dates and timelines are subject to change by the Pennsylvania Department of Human Services.