UPMC Health Plan provider portal, phone and payer ID quick facts
| Provider resource entry point | https://www.upmchealthplan.com/providers/online/default.aspx |
|---|---|
| Payer contact reference | 1-866-918-1595 |
| Claims payer ID | 23281 — UPMC Health Plan claim submission through the stated clearinghouse route; confirm current trading-partner setup. |
| Eligibility payer ID | 23281 — registry reference; verify the member product, transaction and clearinghouse |
| ERA payer ID | 23281 — registry reference; verify the member product, transaction and clearinghouse |
| Timely filing | 90 days (verify applicability) |
| Prior auth route | Verify the current product policy and delegated reviewer; X12 278 support is not established by a portal link |
| Last reviewed | 2026-04-23 |
- This registry has not established a payer-specific appeal ladder for UPMC Health Plan. Use the denial notice, plan document, provider agreement, or jurisdictional rule to assign the correct route and deadline. Missing registry evidence does not mean appeal rights are unavailable.
UPMC Health Plan at a glance
| Legal name | UPMC Health Plan, Inc. |
|---|---|
| Also known as | UPMC |
| Category | Commercial |
| Parent organization | UPMC (University of Pittsburgh Medical Center) |
| Claims payer ID | 23281 — UPMC Health Plan claim submission through the stated clearinghouse route; confirm current trading-partner setup. |
| Eligibility (270/271) payer ID | 23281 — registry reference; verify the member product, transaction and clearinghouse |
| ERA (835) payer ID | 23281 — registry reference; verify the member product, transaction and clearinghouse |
| NAIC company code | Not established in this registry |
| States covered | Pennsylvania, West Virginia, Ohio |
| Members covered | ~4.0 million members |
| Provider resource entry point | https://www.upmchealthplan.com/providers/online/default.aspx |
| Provider phone | 1-866-918-1595 |
Always verify claims-routing details against the member ID card and the payer's current EDI companion guide before submission.
Timely filing & appeals for UPMC Health Plan
This registry lists 90 days as an initial-claim reference for UPMC Health Plan. Confirm the applicable product, provider agreement, start event and current payer instructions. Do not apply this value automatically to out-of-network, secondary, corrected or appealed claims.
| Submission type | Window |
|---|---|
| Initial claim reference | 90 days (verify applicability) |
| Out-of-network initial claim | Verify the member's plan and applicable out-of-network rules |
| Secondary / coordination of benefits | Verify the allowed window and start event; a primary EOB does not automatically restart filing |
| Corrected claim | Verify correction instructions; do not substitute an appeal deadline |
| Reconsideration / appeal | Use the applicable denial or decision notice and the process below |
This registry has not established a payer-specific appeal ladder for UPMC Health Plan. Use the denial notice, plan document, provider agreement, or jurisdictional rule to assign the correct route and deadline. Missing registry evidence does not mean appeal rights are unavailable.
Source: UPMC Health Plan provider policy. Always confirm before disputing a TFL denial — payer policies are versioned and product-specific.
Prior authorization with UPMC Health Plan
Decision deadlines depend on the product, service and urgency. CMS-0057-F generally starts its decision-timeframe requirements in 2026 for Medicare Advantage, Medicaid and CHIP payers subject to the rule: seven calendar days for standard requests and 72 hours for expedited requests. Those requirements exclude drug authorizations and QHP issuers on the federally facilitated exchanges. Other plans, state rules and permitted extensions can differ. Check the applicable policy; a decision deadline is not a guarantee of approval.
CMS-0057-F decision-timeframe requirements and exclusions
Verify UPMC Health Plan electronic claims (837), eligibility (270/271), remittance (835) and authorization (278) separately for the member product and clearinghouse. Registry flags and routing references are not current transaction-complete approval. Confirm the companion guide, enrollment and applicable source findings below. A blank or unverified field does not establish that the transaction is unavailable. Authorization requirements and submission channels depend on the product, service and delegated reviewer. Verify the applicable policy before scheduling; a portal listing is not proof of X12 278 connectivity.
This registry does not provide a current prior-authorization code list for UPMC Health Plan. Start with the provider resources or the policy documents below, then confirm the applicable product, service and effective date. A resource link does not establish that a live code-lookup tool is available.
Top denial reasons for UPMC Health Plan
Per-payer denial benchmarks publish here once the QuickIntell anonymized ETL pipeline ingests sufficient UPMC Health Plan volume. Until then, see the broader CARC reference for industry-wide remediation guides.
Electronic claims, eligibility & ERA
| Transaction | Registry indication — not verification | Routing reference |
|---|---|---|
| 837P / 837I claims | Listed in registry; verify current scope | 23281 — UPMC Health Plan claim submission through the stated clearinghouse route; confirm current trading-partner setup. |
| 270 / 271 eligibility | Listed in registry; verify current scope | 23281 — registry reference; verify the member product, transaction and clearinghouse |
| 278 prior authorization | Listed in registry; verify current scope | Verify X12 278 routing separately |
| 835 ERA | Verify support and enrollment separately | 23281 — registry reference; verify the member product, transaction and clearinghouse |
Payer IDs vary by clearinghouse — confirm against your clearinghouse payer list (Availity, Change Healthcare/Optum, Waystar) before configuring submitter routing.
Source checks and remaining limits
The latest partial comparison is dated . Retained earlier findings keep their original dates below. This is a partial source check, not a whole-page, clinical or legal review. It does not refresh the legacy review date above.
portal_url
Source comparison: 2026-09-26
Use the current Provider OnLine entry, which explicitly supports provider accounts and claim tools.
Primary source for portal_urlpayer_ids.claims
Source comparison: 2026-09-26
23281 is documented in the WebMD clearinghouse claim-submission example; it is not evidence for every eligibility/ERA channel.
Primary source for payer_ids.claimselectronic_claims_supported / supports_279_271
Source comparison: 2026-09-26
837 claims and 270/271 companion resources are documented; 835 requires separate setup.
Primary source for electronic_claims_supported / supports_279_271
Not checked in this pass: Whole-record approval, legal identity, ownership and complete product coverage; Authenticated transactions and QuickIntell integrations; provider_phone / timely_filing_days / payer_ids.eligibility / payer_ids.era / era_payer_id / supports_278: Current phone-tab extraction and filing policy were not verified.23281 cannot be copied to every transaction; 278 is not documented here..
Sources used for this guide
State coverage
UPMC Health Plan operates in the following states. Each link opens state-level Medicaid program details, dominant commercial payers, and state-specific RCM regulations.
Evaluate QuickIntell workflow fit for UPMC Health Plan
These module references are evaluation starting points, not evidence of a validated connection, supported transaction or customer deployment. Confirm the actual member plan, data access and product scope first.
- QuickRCM
Evaluate claim preparation, follow-up and denial worklists for UPMC Health Plan; verify the actual plan rules and available connections before implementation.
- QuickAuth
Assess authorization-packet and status workflows for UPMC Health Plan; confirm product, service, delegated reviewer and permitted submission channels.
- QuickERA
Verify the actual 835 files, posting exceptions and reconciliation requirements for UPMC Health Plan before evaluating automation. An ERA identifier alone does not establish supported ingestion or posting.
Frequently asked questions about UPMC Health Plan
Where is the UPMC Health Plan provider portal?
Use https://www.upmchealthplan.com/providers/online/default.aspx as a starting point for UPMC Health Plan provider resources. This link may open a directory or contact page rather than a transaction portal. Select the applicable product and administrator, then verify the available functions, enrollment and access requirements. QuickIntell is not the official payer portal.
What is the timely filing limit for UPMC Health Plan?
This registry lists 90 days as an initial-claim reference for UPMC Health Plan. Confirm the applicable product, provider agreement, start event and current payer instructions. Do not apply this value automatically to out-of-network, secondary, corrected or appealed claims.
What is the UPMC Health Plan payer ID?
Claims: 23281 — UPMC Health Plan claim submission through the stated clearinghouse route; confirm current trading-partner setup.. Eligibility (270/271): 23281 — registry reference; verify the member product, transaction and clearinghouse. ERA (835): 23281 — registry reference; verify the member product, transaction and clearinghouse. Do not substitute a claims ID for an unverified transaction ID. Check current source findings and the member ID card before submitting.
Does UPMC Health Plan accept electronic claims?
Verify UPMC Health Plan electronic claims (837), eligibility (270/271), remittance (835) and authorization (278) separately for the member product and clearinghouse. Registry flags and routing references are not current transaction-complete approval. Confirm the companion guide, enrollment and applicable source findings below. A blank or unverified field does not establish that the transaction is unavailable.
How do I appeal a UPMC Health Plan denial?
This registry has not established a payer-specific appeal ladder for UPMC Health Plan. Use the denial notice, plan document, provider agreement, or jurisdictional rule to assign the correct route and deadline. Missing registry evidence does not mean appeal rights are unavailable.
How long do UPMC Health Plan prior authorization approvals take?
Decision deadlines depend on the product, service and urgency. CMS-0057-F generally starts its decision-timeframe requirements in 2026 for Medicare Advantage, Medicaid and CHIP payers subject to the rule: seven calendar days for standard requests and 72 hours for expedited requests. Those requirements exclude drug authorizations and QHP issuers on the federally facilitated exchanges. Other plans, state rules and permitted extensions can differ. Check the applicable policy; a decision deadline is not a guarantee of approval.
What is the UPMC Health Plan provider phone number?
This registry lists 1-866-918-1595 as a contact reference for UPMC Health Plan. Confirm the number and service scope against the member ID card and current product-specific directory; claims, eligibility and authorization inquiries may use different teams.
For revenue-cycle teams
Connect payer lookups to your revenue-cycle workflow
Do staff repeatedly move between payer references, eligibility checks, claim status and remittance follow-up?
- Keep this payer's official reference available to the team.
- Identify one repeated administrative task and measure its handling time.
- Evaluate the required access, exceptions and reviewer handoff before expanding automation.
UPMC Health Plan is an operational reference. Payer decisions remain with the payer. Confirm plan coverage, system access and supported actions during a scoped evaluation.
Download the illustrative workflow worksheet (PDF) · Explore the AI RCM evaluation toolkit · Model the workload and costs
Automate workflows around UPMC Health Plan requirements
Connect eligibility, prior authorization, pre-submission claim checks, and remittance routing in one governed workflow. Payer and plan configuration is confirmed during implementation.
Disclaimer
This page is operational reference for medical-billing professionals. It is not legal, clinical, or contractual advice. Payer policies change without notice — always verify against UPMC Health Plan's current published documents before submission. CPT® is a registered trademark of the American Medical Association.