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  • Upmc Out Of Network Claim Form

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Member Claim Form for Routine Vision Important: This form is intended for use by members who receive services from providers outside of the OptiCare Managed Vision provider network. Please do not.

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How to find your 1095-A online Log in to your HealthCare.gov account. Under "Your Existing Applications," select your 2022 application — not your 2023 application. Select “Tax Forms” from the menu on the left. Download all 1095-As shown on the screen.

UPMC Health Plan accepts claims up to 180 days after the date of service for UPMC Community HealthChoices (Medical Assistance), UPMC for Kids (CHIP), and UPMC for You (Medical Assistance) Members. UPMC for You EPSDT claims must be submitted within 90 days after the date of service.

Certificate of Coverage: The legal contract between you and UPMC Health Plan. The contract notes your rights as a member and also details UPMC Health Plan's obligations as a health insurer. It provides detailed descriptions of covered services and lists services that are not covered.

EPO vs PPO eligible expenses You must stay within the network providers for the EPO and PPO for full coverage. A PPO offers more flexibility with limited coverage or reimbursement for out-of-network providers. An EPO is more restrictive, with less coverage or reimbursement for out-of-network providers.

To speak with a customer service associate, please call 412-864-0284 or toll-free 1-844-591-5949. For questions about your UPMC Health Plan bill, please contact Member Services at 1-888-876-2756 or TTY 711. Hours: Monday - Friday: 7 a.m. - 7 p.m.

UPMC for You can help provide you with medical, maternity, vision, and dental care as well as no-cost or low-cost prescription drugs when you get sick. We handle that all - and much more - so you can live your life with less worry.

You will need your member ID number to log in. If you do not have your member ID number, call Member Services at 1-888-499-6885. From the homepage, click on “order new ID card” under “Online Services.”

UPMC Health Plan, headquartered in Pittsburgh, Pennsylvania, is among the nation's fastest-growing health plans. It is owned by the University of Pittsburgh Medical Center (UPMC), a world-renowned health care provider.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232