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How do I report UPMC Health Plan fraud?

• Fraudulent activity by a UPMC Health Plan provider or Member or Participant can be reported by calling the UPMC Health Plan Special Investigation Unit (SIU) at 1-866-FRAUD-01. Once issues have been identified, a plan to correct the issue needs to be developed. The SIU can assist with a corrective action plan development.

How do I get a refund from UPMC Health Plan?

• Refunds should be sent to the Claims Payable Department at the following address: UPMC Health Plan Claims Payable Department U.S. Steel Tower, 36th Floor 600 Grant Street Pittsburgh, PA 15219 If UPMC Health Plan has paid in error and the provider has not sent a refund the overpayments will be deducted from future claim payments.

How does UPMC health plan manage administrative costs?

• To make this possible, UPMC Health Plan requests that providers submit claims promptly and include all necessary data elements. A key to controlling administrative costs is reducing excess paperwork, particularly paperwork generated by improperly completed claims. Key Points

What is UPMC Health Plan’s policy on errors paid in error?

• If UPMC Health Plan has paid in error, providers are given 45 calendar daysto refund the stated overpaid amount to UPMC Health plan. Providers may return the electronic payment or write a separate check for the full amount paid in error.