Documents & Resources for Members
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Please call the UPMC Community HealthChoices Health Care Concierge Team at 1-844-833-0523 (TTY: 711) to request any of these documents in hard copy or alternative format.
- Notice of Privacy Practices
- Out-of-Network Care Claim Form
- UPMC CHC Dental Advantage BLE Form
- Flu Shot Reimbursement Form
- Member Authorization to Use/Disclose PHI
- Personal Representative Designation Form
- 2026 Summary of Benefits
- 2026 Participant Handbook
- Prescription Drug Search
- UPMC Community HealthChoices Pharmacy Formulary (Non-PDL) (PDF) - UPMC Community HealthChoices Pharmacy Formulary (Non-PDL) (JSON)
- Pharmacy Directory
- Provider Directory Search
- UPMC Health Plan member site
- Participant Advisory Committee Application
- Participant Advisory Committee Application (PDF)
- Southwest PA – Participant Advisory Committee Meeting Minutes
- Southeast PA – Participant Advisory Committee Meeting Minutes
- Northwest PA – Participant Advisory Committee Meeting Minutes
- Northeast PA – Participant Advisory Committee Meeting Minutes
- Lehigh/Capital – Participant Advisory Committee Meeting Minutes
- Caring for Your Health newsletter
- Caring for Life newsletter
CHC Member Healthy Lifestyle Articles
- CHC Member Healthy Lifestyle Article – Back Pain
- CHC Member Healthy Lifestyle Article – Heart Disease
- CHC Member Healthy Lifestyle Article – Doctor Visit
- CHC Member Healthy Lifestyle Article – Stress
- CHC Member Healthy Lifestyle Article – Chronic Condition
- CHC Member Healthy Lifestyle Article – Oral Hygiene
- CHC Member Healthy Lifestyle Article – Asthma
- CHC Member Healthy Lifestyle Article – Lifestyle
- CHC Member Healthy Lifestyle Article – Osteoporosis
繁體中文/Mandarin (Chinese):
- 个人代表委托表 – Personal Representative Designation Form
- 参与者手册 – 2026 Participant Handbook
- 隐私惯例通知 - Notice of Privacy Practices
- 关爱 您的健康 – Caring for Your Health Newsletter
Русский/Russian:
- Форма назначения личного представителя – Personal Representative Designation Form
- Справочник участника программы – 2026 Participant Handbook
- Уведомление о порядке использования конфиденциальной информации - Notice of Privacy Practices
- Забота о здоровье - Caring for Your Health Newsletter
عربي/Arabic:
- نموذج تعيين الممثل الشخصي
Personal Representative Designation Form - دليل المشاركين لعام
2026 Participant Handbook - إشعار ممارسات الخصوصية
Notice of Privacy Practices - ینلكعصحتةبا اینلكعصحتةبا ا
Caring for Your Health Newsletter
नेपाली/Nepali:
- व्यक्यनतिगत प्रति निधि नियुक् ति फाराम - Personal Representative Designation Form
- सहभाागीी पुुस्तििकाा - 2026 Participant Handbook
- गोपनीयता अभ्यासहरूको सूचना - Notice of Privacy Practices
- तपााईंंकोो स्वाास्थ्यकोो हेेरचााह गर्नेे - Caring for Your Health Newsletter
Prior Authorization Metrics for Medical Items and Services (Excluding Drugs)
To comply with the CMS Interoperability and Prior Authorization final rule, UPMC Community HealthChoices is required to annually report aggregated prior authorization metrics on our website. This includes a list of all medical items and services (excluding drugs) that require prior authorization, as well as data on prior authorization requests for those items and services (approvals, denials, etc.) during the previous calendar year. Publicly reporting these metrics promotes transparency and accountability, helps patients understand prior authorization processes, and enables providers to evaluate payer performance. In addition, metrics can be used to compare plans, programs, and payers. If you have questions about the data below, please contact Member Services.
These are the medical items and services for which we require prior authorization (excluding drugs)
Beginning Jan. 1, 2026, the CMS Interoperability and Prior Authorization final rule requires UPMC Community HealthChoices to send prior authorization decisions within:
• 72 hours for expedited requests (urgent).
• 7 calendar days for standard requests (nonurgent).
Standard/Expedited Quantities/Review Time data