Password: Please use the following link to return to the UPMC Health Plan home pageUPMC Health Plan home page For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. Patients of UPMC Cole should select the UPMC Cole Connect Patient Portal. 2022 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences. Pharmacy . When care is coordinated, submit the referring provider NPI if available, as well as the name and UPIN. Your dedicated network manager can answer questions and keep you current on new benefits, features, and products. Receive 24-hour access to claims and coverage information. Find a UPMC health care facility close to you quickly by browsing by region. UPMC Health Plan and SKYGEN Product Guide. Behavioral Health . Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. Complete testing and become certified with UPMC Health Plan. Log In to the Dental Advantage Provider Portal Announcements Get the latest updates from UPMC Health Plan. These claims are loaded into batches and immediately posted in preparation for adjudication. Sign in ; Register . For Providers About Contact . Find listings of the care providers we partner with including doctors, hospitals, pharmacies . Our clients of insurance companies, third-party administrators and various groups lease the DenteMax PPO network for use in their dental benefit plans in order to service their more than 20 million members nationwide. Claims should be submitted using one of the methods below: Clearinghouse Submission: Login/Register. Search adult and pediatric providers and schedule appointments online. For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. This person will: If you have not accessed your Provider OnLine account in the past six months, your account may be disabled. Sign in to UPMC Cole Connect Patient Portal. 2599 Wexford Bayne Road, Sewickley, PA 15143 (Map) 724-933-3700. Our Provider Partner Update newsletter includes the latest news and information for network providers. Interact with the Health Plan on claims issues via a messaging system. The UPMC Presbyterian Dental Center at UPMC Montefiore offers preventive and follow-up dental care. In the meantime, if you need to verify eligibility, plan information or submit a claim, please follow the instructions below. Your Username or Password? Online Login: UserID I forgot my user id (Members Only) : There was an error with the Pass through from your Public Website. Medicare: UPMC for Life Dental Advantage (University of Pittsburgh retirees only) Find out how to apply for Dental HMO/Managed Care Plan^. To verify eligibility and plan information, please call: Claims and pre-determinations should be submitted using one of the methods below: Clearinghouse Submission: Commercial and Medicare The plan is designed to encourage regular preventive care and foster open communication between patients and dentists regarding recommended treatment plans. First-time users can create a Provider OnLine account. If you can't log in, contact Sales Support at 1-855-862-6515. Batch file submissions This portion of the UPMC Health Plan's website is strictly related to HIPAA-mandated EDI transactions. Get the latest news and information about the Dental HMO/Managed Care Network^ and Products. As a network provider, you can: Verify eligibilitycheck plan status with a member's ID, full name, and date of birth. View up-to-date eligibility, PCP information, and covered benefits. Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. I am a: Login. View resources for medical providers, log into Provider OnLine, and get access to downloadable forms. View UPMC's other Patient Portals. View members' historical coverage information. the introduction of UPMC Dental Advantage. Providers submitting claims through Use billing software that allows the generation of a HIPAA-compliant 837 professional or institutional file. 412-647-8762 Register. Login/Register. 2022 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences. . Find care with UPMC Health Plan's Provider Directory. UPMC Dental Advantage Provider Portal Visit our secure website, where network providers can sign in and complete most administrative tasks. In order to submit EDI files directly to the Health Plan, providers must: UPMC Health Plan currently accepts dual provider identifiers. The UPMC Presbyterian Dental Center at UPMC Montefiore offers preventive and follow-up dental care. Emdeon should use payer ID 23281. Forgot username or password? Advantage Dental Provider Portal We have moved! It is important that you respond to VPoint to ensure your continued relationship with MetLife. Children's Health Insurance Program: UPMC for Kids (CHIP) Dental Advantage Contact Our Dental Benefits Advisory Team, Join our UPMC Dental Advantage Provider Network, ONC 21st Century Cures Act Member Resource Center. 800-533-8762. Provider OnLine Features With UPMC Health Plan's Provider OnLine, you can: Submit claim forms to: Member Login. Start Here. to earn CE credits without leaving the office. var year = now.getFullYear() Have a sample 837 file exported from their billing system containing only UPMC Health Plan claims. PO Box 1600 . You can follow up with additional questions to the HealthPlanEDI@upmc.edu distribution group. Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. Your health information, right at your fingertips. UPMC Health Plan accepts electronic claims in data file transmissions. Sign in/Register I am a:MemberProviderEmployerProducer Sign In Please enter your username. Thank you for being a part of the UPMC Dental Advantage/UPMC Vision Advantage network. Discover the advantages of joining, and learn about resources available to you as a network provider. Providers are able to submit claims directly without incurring clearinghouse expenses. To learn more, visit healthwise.org. Don't have one? With UPMC Health Plan's Provider OnLine, you can: A provider office should appoint a staff member to serve as Security Officer. As a network dentist, youll get help with claims status, eligibility, and more. Call your provider's office or 1-800-533-8762. Were happy to give you more information about becoming a UPMC Dental Advantage provider. If you have questions while you are completing the form, contact our Web Support Services at 1-800-937-0438. For a medical emergency, call 911 or go to the nearest emergency department. For nearly 30 yearsSKYGEN has been a trusted partner in a changing dental landscape, offering the tools and support you need to enhance your business while providing exceptional patient care. 205 Millers Run Road, Suite 300, Bridgeville, PA 15017 (Map) 724-934-3334. Announcements UPMC for You Dental Advantage For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. Forgot Password? 2022 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences. Browse doctors by specialty, procedure, service, or equipment to find the best fit for you! Forgot Login/Register. Login This application is best viewed using Internet Explorer versions 6.0 and higher Login As Provider Network Login Name Password Home Forgot Password? These clearinghouses are then responsible for reformatting these claims to meet HIPAA standards and passing the claims on to the Health Plan. Pittsburgh, PA 15230-1600, Join our UPMC Dental Advantage Provider Network, ONC 21st Century Cures Act Member Resource Center. For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. If you are interested in HIPAA-compliant EDI file submission, please refer to the additional set-up documents on this website. // Array of day names Search adult and pediatric providers and schedule appointments online. Find out how to apply for the Preferred Dentist Program, Find out how to apply for Dental HMO/Managed Care Plan^, MetLife Dental Health Maintenance Organization (DHMO)/Managed Care Network^. Read Dental Announcements Please submit the National Provider Identifier (NPI), along with the tax ID and the provider ID as assigned by UPMC Health Plan. Participants who need help finding a dental provider, or have questions about their dental benefit, can call the UPMC Community HealthChoices HealthCare Concierge team at 1-844-833-0523 (TTY: 711). The Act creates specific negotiation and dispute resolution protocols between payer and provider. For help utilizing the provider web portal, registering, or requesting training, contact SKYGEN's Portal Services Team at dentalproviderportal@skygenusa.com or call 1-844-621-4576. For a medical emergency, call 911 or go to the nearest emergency department. Chat with a UPMC Health Plan provider service representative in real time. Watch and learn more about Provider OnLine, Appendix A COVID-19 Special Coverage and Payment Policy, NSA Negotiation Information for Providers, Provider Disclosure of Ownership and Control, Expedited Provider Appeal Certification Form, EPSDT Clinical and Operational Guidelines, Continuing Medical Education (CME) Resources, Join our UPMC Dental Advantage Provider Network, ONC 21st Century Cures Act Member Resource Center. The Federal No Surprises Act within the Consolidated Appropriations Act of 2021 provides for out-of-network and balance billing protections for out-of-network Emergency, Air Ambulance, and certain services rendered at in-network facilities. Get virtual care Schedule a video visit with your regular provider. *Disclaimer: This online directory provides a list of UPMC Health Plan providers, and the information contained here is updated periodically. Our Dental Benefits Advisory Team is ready to answer your call. Interested in joining UPMC Health Plans provider network? For general assistance or inquiries regarding web portals or logins, please contact us here. Medical . About the Electronic Remittance Advice We are committed to offering industry-leading coverage to our memberssubject to federal, state, and local regulationsand to supporting our network providers as they deliver cost-effective, quality care. Login to Provider Online. To request a direct interface of an 835 formatted ERA file, from this website or via PGP encrypted file transfer, please complete the 835 Request Form and send via email to HealthPlanEDI@upmc.edu. Here you can explore resources and information about Medical Assistance coverage and benefits. I am a: Login. If your billing system transmits claims to UPMC via a clearinghouse please contact your vendor, or clearinghouse, for instructions on how to automate the processing of ERA's in an 835 format. Get the latest updates from UPMC Health Plan, including updates to our Provider COVID-19 FAQ and Appendix A COVID-19 Special Coverage and Payment Policy. However, some plan providers may have been added or removed from the list (and/or contact information may have changed) since this directory was last updated. Need to schedule by phone? Providers. Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. UPMC Community HealthChoices Dental Allowance Request Form. Search adult and pediatric providers and schedule appointments online. var monthNames = new Array( Download a form for your practice, update your profile, or learn how to report fraud and abuse. UPMC Dental Advantage Medicare Provider Services 1-844-761-0081 Claims and pre-determinations should be submitted using one of the methods below: Clearinghouse Submission: Providers submitting claims through Emdeon should use payer ID 23281. How to Login? UPMC Vision Advantage Patients of UPMC Cole should select the UPMC Cole Connect Patient Portal. Our dental health team at UPMC Cole offers high-quality family dental care at affordable pricing. Providers who have existing relationships with clearinghouses such as WebMD (UPMC Health Plan Payer ID: 23281), NDC, and HDS can continue to transmit claims in the format produced by their billing software. Electronically filed claims may be submitted in the following ways: Individual claim entry Determine a patient's primary insurance coverage. As the only provider-led health insurer in western Pennsylvania, we recognize the importance of partnership with network physicians and sensitivity to doctor-patient relationships. Per HIPAA, the only permissible format for an electronic remittance advice (ERA), in a data file, is the ANSI ASC X12.835, Health Care Claim Payment/ Advice, commonly referred to as an 835. Get an immediate response if mistakes are made submitting a claim (using HIPAA 837 forms). Give us feedback on Provider OnLine. Individual claim entry, known as Prelog, is available to providers with established Health Plan online accounts. We offer personalized dental care at UPMC Montefiore in Pittsburgh and UPMC Cole in Coudersport and Port Allegany, Pa. Western Pa. DenteMax is one of the largest leasable dental PPO networks in the United States. If you need assistance, please call our Help Desk at 1-800-937-0438. If you forgot your user ID or need assistance, please call our Help Desk at 1-800-937-0438. Search adult and pediatric providers and schedule appointments online. For a medical emergency, call 911 or go to the nearest emergency department. As a participating provider, you can access valuable information online by entering your user ID and password in the login box on this page. Someone will contact you. Need to schedule by phone? SIGN The portal for all UPMC patients EXCEPT those in Central Pa. We also treat serious dental issues to help you keep smiling. While UPMC does offer the option to generate 835 formatted ERA files (and make them available for direct download via this website) many automated billing systems interface with payers via a clearinghouse. UPMC Dental Advantage First-time users can create an account by contacting their office Provider OnLine Account Administrator or by calling 1-800-937-0438. Dominion National provides dental plans and administrative services to UPMC Health Plan members and maintains an extensive selection of participating dentists. Account Login | MyUPMC Log In To Your Account Username Password Sign Up Forgot Username? Our Dental Advantage Newsletter includes the latest news and information for network providers. UPMC Health Plan and SKYGEN Clinical Criteria effective 12/18/2022. Contact Us Current Members. Through MetDental, participating Dentists can view rosters, search for Explanation of Payment statements, download Facility Reference Guides, and more. Your Username or Password? UPMC Dental Advantage offers competitive rates, convenient tools, and rapid reimbursement. UPMC Dental Advantage offers UPMC employees two options Standard and Premium with a network of fully credentialed dentists. For a medical emergency, call 911 or go to the nearest emergency department. Need to schedule by phone? var dayNames = new Array("Sunday","Monday","Tuesday","Wednesday","Thursday","Friday","Saturday"); As a provider-led health insurer, we have a unique appreciation for our relationships with network doctors and care providers. Pittsburgh, PA 15230-1600. It requires the recipient's Practice or Billing System have the ability to automate loading of a file in the mandated format. Providers submitting claims through Forgot username or password? Grant access to Provider OnLine to certain staff members on the provider's behalf. MetLife is committed to helping our providers have a smooth transition to our new enrollment solution with as little disruption as possible. Find care with UPMC Health Plan's Provider Directory. Emdeon should use payer ID 25184. I am a: Login. Phone: 1-800-286-4242. 2023 MetLife Services and Solutions, LLC, VPoint Credentialing and Recredentialing Services. For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. Browse doctors by specialty, procedure, service, or equipment to find the best fit for you! 200 Lothrop Street Pittsburgh, PA 15213 412-647-8762 800-533-8762 How to Login? 1 Childrens Hospital Drive, 4401 Penn Avenue, Floor 7, Pittsburgh, PA 15224 (Map) Children's North Ambulatory Surgery Center. Existing EFT payments set up with MetLife will remain unchanged, so no action is required on your part. Our provider portal solutions make business transactions fast, simple and convenient, including: Learn how SKYGEN's solutionsstreamline dental administration so you can focus on patient care. document.write(dayNames[now.getDay()] + ", " + monthNames[now.getMonth()] + " " + now.getDate() + ", " + year); User name: . Find care with UPMC Health Plan's Provider Directory. Medical Assistance: UPMC Health Plan's claims processing system allows providers to take advantage of enhanced access to information, including the ability to immediately correct claims that have missing information, incorrect procedure codes, or other errors. Claim files are transmitted using a secure FTP process that does not require data encryption prior to transmission. You can request that your account be reactivated by contacting 1-800-937-0438. At this time, only PPO providers currently receiving their payments by checks will be included in this phase. Forgot username or password? Our provider portal solutions make business transactions fast, simple and convenient, including: Submission of dental claims and prior authorizations . More Contact Options ; . Providers may use the standard PGP encryption process in addition to the secure FTP, if additional data security is desired. Not registered with UPMC Health Plan? Start Here. Login This application is best viewed using Internet Explorer versions 6.0 and higher Login As Provider Network Login Name Password Home Forgot Password? Pittsburgh, PA 15213 Paper Claim Submission: For a medical emergency, call 911 or go to the nearest emergency dept. plan detail, and claims. // Array of month Names For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. Our dental experts can help you to put your best face forward. DHMO providers will continue to receive paper checks and/or EFT payments as they do today, no action is required for DHMO payments. Dental . Browse doctors by specialty, procedure, service, or equipment to find the best fit for you! Resources for Dental Providers Vision Providers Make Provider OnLine security requests to UPMC Health Plan on behalf of other staff members. So many helpful features. Paper Claim Submission: Submit claim forms to: UPMC Dental Advantage PO Box 1600 Pittsburgh, PA 15230-1600 Important: Please provide your National Provider Identifier (NPI) when prompted. For member identification, submit the member's 11-digit ID number or the government-assigned identifiers for Medicare or Medical Assistance members. To learn how to register, watch our instructional Provider OnLine registration video. For a medical emergency, call 911 or go to the nearest emergency department. Video Visit. IN So can you. We apologize for this inconvenience and look forward to serving you the next time you sign in. You also can register to join the network. Need Help? Submission of dental claims and prior authorizations, Member status and eligibility determination. UPMC Health Plan and SKYGEN Provider Manual. // patched for y2k bug! View resources for medical providers, log into Provider OnLine, and get access to downloadable forms. Home & Community-Based Services . Please be advised MetLife has contracted VPoint to provide credentialing and recredentialing services on MetLife's behalf. Register. The portal for UPMC Cole patients receiving inpatient care. First-time users can create a Provider OnLine account. We use the latest oral health technology and tools so you can feel good about flashing those pearly whites. Your session has ended, thank you for using UPMC Health Plan OnLine. This feature allows direct submission of both professional (HCFA/CMS-1500) and institutional (UB-92) claims via a user-friendly interface, using the Internet's highest level of security to make the process safe and easy. 2023 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences, Supplemental content provided by Healthwise, Incorporated. Select MyUPMC to access your UPMC health information. Federal Employees: Federal Employees Health Benefits Program (FEHB) Dental Advantage PO Box 1600 Dentistry - Find a Doctor | UPMC Need Care? Dental . Vision . Submit claim forms to: Register. DHMO providers will have the ability to manage all payments under one experience on the Zelis platform in future phases. Find a Doctor or Provider. For a medical emergency, call 911 or go to the nearest emergency dept. var now = new Date(); Learn about the dental products UPMC Health Plan offers and the variety of resources available to network providers. Our provider portal is currently unavailable. Need to schedule by phone? For a medical emergency, call 911 or go to the nearest emergency dept. Please be advised Zelis is the new payment solution for MetLife claim payments. If you need help with your account, please call 1-866-884-8579. Provider OnLine Login Username Sign In If you forgot your user ID or need assistance, please call our Help Desk at 1-800-937-0438. UPMC Community HealthChoices (CHC) Dental Advantage Resources for UPMC Health Plan/SKYGEN Dental Providers. Advantage Dental's Home Support Office is now located at 63140 Britta Street Suite D104, Bend, Oregon 97703 We will be making a few exciting system changes over the next several weeks to help improve provider and member experience! Access your UPMC information in MyUPMC. for a doctor or specialist. Forgot For more information on dental services, view the UPMC Community HealthChoices Handbook . For Providers About Contact . Vision . 200 Lothrop Street UPMC Health Plan and SKYGEN Dental Provider Quick Reference Guide. Dental Care at UPMC Our dental experts can help you to put your best face forward. Via the Provider OnLine EDI tools, these batches can be viewed in several standard report formats. For Providers About Contact Search. To learn how to register, watch our instructional Provider OnLine registration video. For patients of UPMC-affiliated doctors in Central Pa, select UPMC Central Pa Portal.
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