UPMC Behavioral Health Care Management

Community Care provides care management for the behavioral health services of UPMC Health Plan members under the age of 21 who have autism spectrum disorders. This is done under the coordination of UPMC Health Plan’s staff who manage the physical health care needs of this population.

Act 62 specifies that commercial insurance companies must cover ASD services up to $36,000 per benefit year. The annual financial benefit limit changes based on the U.S. Department of Labor Consumer Price Index for All Urban Consumers (CPI-U) and is now greater than $36,000. Members become eligible for Act 62 mandated coverage based on their insurance plan and their benefit year start date. Children covered under CHIP are also eligible under Act 62. The best way to determine if a UPMC Health Plan member is Act 62 eligible is to have the subscriber contact Health Plan Member Services to ask about their status.

Please note the following:

• Use the dedicated autism services care management phone number if you have clinical questions: 1-877-822-3167.
• Claims processing guidelines for UPMC members are available for these services on the Health Plan website.
• Out-of-network service requests require completion of:
  • The Autism Services Fax Cover Sheet. Completed Autism Services Authorization Request Forms should be faxed to 1-888-249-5646.
  • Out-of-Network Request Form. Completed Out-of-Network Request Forms should be faxed to 1-888-249-5646.
• If you would like to become an in-network autism services provider for UPMC Health Plan members, please contact our Network Department: 1-888-251-2224.

Providers who also hold HealthChoices contracts should pay specific attention to the UPMC Health Plan’s claims guidelines as there are different addresses.