CommercialAdministrativeHigh impact
Requirements under the No Surprises Act
UPMC Health Plan·PA·Reimbursement
Effective date
Jan 1, 2022
We identified it
Aug 7, 2026
Summary
The No Surprises Act (NSA), effective January 1, 2022, establishes new requirements for provider directory accuracy and verification. Providers must submit directory information updates to UPMC Health Plan when terminating agreements or making material changes, and must participate in quarterly directory verification through LexisNexis to maintain incentive payment eligibility. Failure to verify quarterly will result in loss of incentive payments.
Action Required
REQUIREMENTS:
- Immediately: All providers must establish a process to submit provider directory information updates to UPMC Health Plan whenever there is a termination of network agreement or material change to directory content. Updates can be made via upmchealthplan.com/providers/change.html or Provider OnLine under Reports/Office Information Sheet.
- Beginning each quarter: Respond to LexisNexis verification requests (via phone, fax, or online) within the timeframe provided to confirm accuracy of provider directory information. Providers can proactively verify information at upmchealthplan.com/find or through Provider OnLine.
- Ongoing: Maintain accurate contact information and promptly notify physician account executive or providernetworkinquiries@upmc.edu of any changes. Failure to participate in quarterly verification will result in loss of incentive payment eligibility.
- Administrative staff and credentialing team are responsible for tracking verification deadlines and responding to LexisNexis outreach.