Medicare AdvantagePrior AuthHigh impact
IMPORTANT UPDATE: Extending the current UPMC Health Plan utilization model for selected MSK, cardiology, and radiology codes
UPMC Health Plan·Cardiology, Radiology, Orthopedics +2 more·Prior Authorization
We identified it
Aug 7, 2026
Summary
UPMC Health Plan is extending a temporary prior authorization expediting process through March 1st for selected MSK, cardiology, and radiology procedures and imaging. Prior authorization requests will be auto-approved without clinical documentation review during this period, but requests must still be submitted with complete information to avoid manual review delays and claim denials.
Action Required
By March 1, 2025: Billing team must ensure all prior authorization requests for MSK, cardiology, and radiology procedures/imaging are submitted with complete information to maximize auto-approval eligibility and avoid manual review delays. Continue submitting prior authorization requests for all related claims during this extension period—claims will not be paid without prior authorization submission, even though clinical documentation review is waived. Flag this deadline internally and prepare for potential workflow changes after March 1st when the expedited process expires.