412-647-8762 Patients of UPMC Cole should select the UPMC Cole Connect Patient Portal. 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. Pharmacy . UPMC Vision Advantage and UPMC Vision Care* make it easy for you to give your patients high-quality vision care and preventive services. Contact Our Dental Benefits Advisory Team, Join our UPMC Dental Advantage Provider Network, ONC 21st Century Cures Act Member Resource Center. The UPMC Presbyterian Dental Center at UPMC Montefiore offers preventive and follow-up dental care. Login/Register. 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. Medicare Special Needs Plans: UPMC for Life Complete Care Dental Advantage. Search adult and pediatric providers and schedule appointments online. The online provider search lets you find a person who provides . 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. Were happy to give you more information about becoming a UPMC Dental Advantage provider. For a medical emergency, call 911 or go to the nearest emergency department. Search adult and pediatric providers and schedule appointments online. Access your UPMC information in MyUPMC. Welcome to MetDental.com. Home & Community-Based Services . For nearly 30 years SKYGEN 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. How to Login?
For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. Learn about the dental products UPMC Health Plan offers and the variety of resources available to network providers. Welcome to UPMC for You! Your Username or Password? If you need help with your account, please call 1-866-884-8579. For a medical emergency, call 911 or go to the nearest emergency department. View plansget vision and dental plan information prior to the member's visit. Please submit the National Provider Identifier (NPI), along with the tax ID and the provider ID as assigned by UPMC Health Plan. Resources for Medical Providers Dental Providers Learn about the dental products UPMC Health Plan offers and the variety of resources available to network providers. . You can follow up with additional questions to the HealthPlanEDI@upmc.edu distribution group. Complete testing and become certified with UPMC Health Plan. Someone will contact you. I am a: Login. 2023 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences, Supplemental content provided by Healthwise, Incorporated. The portal for UPMC Cole patients receiving inpatient care. Our Provider Partner Update newsletter includes the latest news and information for network providers. PO Box 1600
This person will: If you have not accessed your Provider OnLine account in the past six months, your account may be disabled. var now = new Date(); Advantage Dental Provider Portal We have moved! UPMC Community HealthChoices (CHC) Dental Advantage
View members' historical coverage information. Serve as the provider practices primary contact with UPMC Health Plan regarding Provider OnLine security issues. You may search for dentists by zip code, proximity, and type on the provider search tool above for any of the dental options. 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. First-time users can create a Provider OnLine account. 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. Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. SIGN As a provider-led health insurer, we have a unique appreciation for our relationships with network doctors and care providers. If you are interested in HIPAA-compliant EDI file submission, please refer to the additional set-up documents on this website. UPMC Dental Advantage offers UPMC employees two options Standard and Premium with a network of fully credentialed dentists. So many helpful features. Our Dental Advantage Newsletter includes the latest news and information for network providers. Dominion National provides dental plans and administrative services to UPMC Health Plan members and maintains an extensive selection of participating dentists. For technical questions about the UPMC Central PA Portal, contact the Help Desk Mon. Need to schedule by phone? Get virtual care Schedule a video visit with your regular provider. 800-533-8762. Login/Register. The Act creates specific negotiation and dispute resolution protocols between payer and provider. I am a: Login. If you choose this option for claims submission and you do not have a Provider OnLine account, complete this form to sign up. Browse doctors by specialty, procedure, service, or equipment to find the best fit for you! Providers may use the standard PGP encryption process in addition to the secure FTP, if additional data security is desired. For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. Individual claim entry, known as Prelog, is available to providers with established Health Plan online accounts. 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. More Contact Options ; . If you have questions while you are completing the form, contact our Web Support Services at 1-800-937-0438. 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. *Administered by National Vision Administrators, Join our UPMC Dental Advantage Provider Network, ONC 21st Century Cures Act Member Resource Center. Forgot username or password? Grant access to Provider OnLine to certain staff members on the provider's behalf. Log In to the Dental Advantage Provider Portal Announcements Get the latest updates from UPMC Health Plan. If you need assistance, please call our Help Desk at 1-800-937-0438. for a doctor or specialist. UPMC Health Plan accepts electronic claims in data file transmissions. Find out how to apply for the Preferred Dentist Program Vision . When care is coordinated, submit the referring provider NPI if available, as well as the name and UPIN. Dental . 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 Providers About Contact . Make an appointment UPMC Dental Advantage
As a network dentist, youll get help with claims status, eligibility, and more. Member Login. Commercial and Medicare
Important: Please provide your National Provider Identifier (NPI) when prompted. DenteMax is one of the largest leasable dental PPO networks in the United States. Existing EFT payments set up with MetLife will remain unchanged, so no action is required on your part. For additional information, please call SKYGEN Provider Services at 1-855-806-5193 or email providerservices@skygenusa.com. Sign in ; Register . User Login. Login to Provider Online. We also treat serious dental issues to help you keep smiling. Online Login: UserID I forgot my user id (Members Only) : There was an error with the Pass through from your Public Website. Chat with a UPMC Health Plan provider service representative in real time. 2599 Wexford Bayne Road, Sewickley, PA 15143 (Map) 724-933-3700. Select MyUPMC to access your UPMC health information. to earn CE credits without leaving the office. Pittsburgh, PA 15213 var monthNames = new Array( For a medical emergency, call 911 or go to the nearest emergency department. To learn how to register, watch our instructional Provider OnLine registration video. Patients of UPMC Cole should select the UPMC Cole Connect Patient Portal. For a medical emergency, call 911 or go to the nearest emergency department. Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. Please be advised Zelis is the new payment solution for MetLife claim payments. The UPMC Presbyterian Dental Center at UPMC Montefiore offers preventive and follow-up dental care. Find out how to apply for Dental HMO/Managed Care Plan^. Your session has ended, thank you for using UPMC Health Plan OnLine. UPMC for You Dental Advantage
TTY: 711. For a medical emergency, call 911 or go to the nearest emergency department. Read Dental Announcements Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. To learn how to register, watch our instructional Provider OnLine registration video. We offer personalized dental care at UPMC Montefiore in Pittsburgh and UPMC Cole in Coudersport and Port Allegany, Pa. For a medical emergency, call 911 or go to the nearest emergency dept. You also can register to join the network. Interact with the Health Plan on claims issues via a messaging system. UPMC Dental Advantage Provider Portal Visit our secure website, where network providers can sign in and complete most administrative tasks. 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! Providers submitting claims through
Resources for Dental Providers Vision Providers Please use the following link to return to the UPMC Health Plan home pageUPMC Health Plan home page IN Sign in to UPMC Cole Connect Patient Portal. 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. Need to schedule by phone? // Array of month Names Forgot username or password? Through MetDental, participating Dentists can view rosters, search for Explanation of Payment statements, download Facility Reference Guides, and more. Learn more about our plans and programs, find a dentist, or sign in to view patient eligibility, plan detail, and claims. About the Electronic Remittance Advice
In the meantime, if you need to verify eligibility, plan information or submit a claim, please follow the instructions below. Medical Assistance:
How to Login? Receive 24-hour access to claims and coverage information. PO Box 1600
Register. If you forgot your user ID or need assistance, please call our Help Desk at 1-800-937-0438. Please sign in to view patient eligibility, Medicare: UPMC for Life Dental Advantage (University of Pittsburgh retirees only)
Paper Claim Submission:
Find care with UPMC Health Plan's Provider Directory. Paper Claim Submission: Submit claim forms to: UPMC Dental Advantage PO Box 1600 Pittsburgh, PA 15230-1600 Providers. Medical . . 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. Don't have one? Not registered with UPMC Health Plan? Have the ability to download and install a free Active-X secure FTP add-on. Phone: 1-800-286-4242. Submit claim forms to:
Password: Make Provider OnLine security requests to UPMC Health Plan on behalf of other staff members. With UPMC Health Plan's Provider OnLine, you can: A provider office should appoint a staff member to serve as Security Officer. DHMO providers will continue to receive paper checks and/or EFT payments as they do today, no action is required for DHMO payments. 2022 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences. At this time, only PPO providers currently receiving their payments by checks will be included in this phase. 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. // patched for y2k bug! Your place to stay in control. Vision . For a medical emergency, call 911 or go to the nearest emergency dept. Have a sample 837 file exported from their billing system containing only UPMC Health Plan claims. Register. Learn about and take advantage of the resources available to you as a network provider. You can request that your account be reactivated by contacting 1-800-937-0438. Our provider portal solutions make business transactions fast, simple and convenient, including: Submission of dental claims and prior authorizations . Pittsburgh, PA 15230-1600, Join our UPMC Dental Advantage Provider Network, ONC 21st Century Cures Act Member Resource Center. Need to schedule by phone? Via the Provider OnLine EDI tools, these batches can be viewed in several standard report formats. Interested in joining UPMC Health Plans provider network? If you can't log in, contact Sales Support at 1-855-862-6515. Our dental health team at UPMC Cole offers high-quality family dental care at affordable pricing. Use billing software that allows the generation of a HIPAA-compliant 837 professional or institutional file. DHMO providers will have the ability to manage all payments under one experience on the Zelis platform in future phases. UPMC Dental Advantage offers competitive rates, convenient tools, and rapid reimbursement. Contact Us Current Members. View up-to-date eligibility, PCP information, and covered benefits. Learn more about the Preferred DentistProgram and MetLife Dental Health Maintenance Organization (DHMO)/Managed Care Network^ and benefits like an increased patient base, continuing education at NO CHARGE, and more. through Fri., 8 a.m. to 5 p.m. at 1-888-782-5678 or 717-988-0000 press 6 Dental . These clearinghouses are then responsible for reformatting these claims to meet HIPAA standards and passing the claims on to the Health Plan. The portal for UPMC patients in Central Pa. For general assistance or inquiries regarding web portals or logins, please contact us here. // Array of day names First-time users can create an account by contacting their office Provider OnLine Account Administrator or by calling 1-800-937-0438. 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). Download a form for your practice, update your profile, or learn how to report fraud and abuse. For a medical emergency, call 911 or go to the nearest emergency dept. Determine a patient's primary insurance coverage. Pittsburgh, PA 15230-1600. The provider's office can enter claims and verify if they have been accepted and are ready for adjudication. I am a: Login. Here you can explore resources and information about Medical Assistance coverage and benefits. The portal for all UPMC patients EXCEPT those in Central Pa. Thank you for being a part of the UPMC Dental Advantage/UPMC Vision Advantage network. UPMC Community HealthChoices is one of the managed care organizations selected to provide Community HealthChoices (CHC) services in Pennsylvania to those who qualify for Medical Assistance and also qualify for Medicare or require a nursing facility level of care. var year = now.getFullYear() Forgot Password? document.write(dayNames[now.getDay()] + ", " + monthNames[now.getMonth()] + " " + now.getDate() + ", " + year); User name: Health Care Claim Status Request & Response (276/277), Provider OnLine Account Administrator Application, 837 Companion Document Professional Claims File, 837 Companion Document Institutional Claims File, Desktop Setup for File Submission and Implementation, Join our UPMC Dental Advantage Provider Network, ONC 21st Century Cures Act Member Resource Center. Get the latest news and information on the EFT/ERA Overview page in the resource center. Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. Get the latest news and information about the Dental HMO/Managed Care Network^ and Products. Our dental experts can help you to put your best face forward. Electronically filed claims may be submitted in the following ways: Individual claim entry
Search adult and pediatric providers and schedule appointments online. Batch file submissions
Get the latest resources, news, and announcements from UPMC Health Plan for participating providers. UPMC Community HealthChoices Dental Allowance Request Form. Login This application is best viewed using Internet Explorer versions 6.0 and higher Login As Provider Network Login Name Password Home Forgot Password? Need to schedule by phone? If you forgot your User ID or need assistance, please call our Help Desk at 1-800-937-0438. the introduction of UPMC Dental Advantage. Submission of dental claims and prior authorizations, Member status and eligibility determination. Login This application is best viewed using Internet Explorer versions 6.0 and higher Login As Provider Network Login Name Password Home Forgot Password? Give us feedback on Provider OnLine. 200 Lothrop Street Pittsburgh, PA 15213 412-647-8762 800-533-8762 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. You also can register to join the network. Forgot Manage claimssubmit and manage claims entirely online. var dayNames = new Array("Sunday","Monday","Tuesday","Wednesday","Thursday","Friday","Saturday"); Federal Employees: Federal Employees Health Benefits Program (FEHB) Dental Advantage
Search adult and pediatric providers and schedule appointments online. It requires the recipient's Practice or Billing System have the ability to automate loading of a file in the mandated format. Paper Claim Submission:
Not a UPMC Central PA Portal Patient? Access formsfind provider manuals, plan sheets, lab program forms . Dental . Please be advised MetLife has contracted VPoint to provide credentialing and recredentialing services on MetLife's behalf. We apologize for this inconvenience and look forward to serving you the next time you sign in. Emdeon should use payer ID 23281. For patients of UPMC-affiliated doctors in Central Pa, select UPMC Central Pa Portal. Dentistry - Find a Doctor | UPMC Need Care? Announcements 1 Childrens Hospital Drive, 4401 Penn Avenue, Floor 7, Pittsburgh, PA 15224 (Map) Children's North Ambulatory Surgery Center. Discover the advantages of joining, and learn about resources available to you as a network provider. Resources for UPMC Health Plan/SKYGEN Dental Providers. Browse doctors by specialty, procedure, service, or equipment to find the best fit for you! We offer personalized dental care at UPMC Montefiore in Pittsburgh and UPMC Cole in Coudersport and Port Allegany, Pa. Western Pa. Video Visit. 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. In order to submit EDI files directly to the Health Plan, providers must: UPMC Health Plan currently accepts dual provider identifiers. The plan is designed to encourage regular preventive care and foster open communication between patients and dentists regarding recommended treatment plans. Providers submitting claims through
2022 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences. Find care with UPMC Health Plan's Provider Directory. Your dedicated network manager can answer questions and keep you current on new benefits, features, and products. Find care with UPMC Health Plan's Provider Directory. It is important that you respond to VPoint to ensure your continued relationship with MetLife. UPMC Health Plan and SKYGEN Dental Provider Quick Reference Guide. Start Here. 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^. Need to schedule by phone? So can you. 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. For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. For Providers About Contact . Start Here. This portion of the UPMC Health Plan's website is strictly related to HIPAA-mandated EDI transactions. For member identification, submit the member's 11-digit ID number or the government-assigned identifiers for Medicare or Medical Assistance members. Providers are able to submit claims directly without incurring clearinghouse expenses. View resources for medical providers, log into Provider OnLine, and get access to downloadable forms. Call your provider's office or 1-800-533-8762. 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. Sign in/Register I am a:MemberProviderEmployerProducer Sign In Please enter your username. 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. Dentists in our network enjoy top-notch support that makes it easier to run a successful practice. 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. These claims are loaded into batches and immediately posted in preparation for adjudication. Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. Get an immediate response if mistakes are made submitting a claim (using HIPAA 837 forms). Forgot username or password? As a participating provider, you can access valuable information online by entering your user ID and password in the login box on this page. 2023 MetLife Services and Solutions, LLC, VPoint Credentialing and Recredentialing Services. Find a UPMC health care facility close to you quickly by browsing by region. To verify eligibility and plan information, please call: Claims and pre-determinations should be submitted using one of the methods below: Clearinghouse Submission:
To learn more, visit healthwise.org. plan detail, and claims. MetLife is committed to helping our providers have a smooth transition to our new enrollment solution with as little disruption as possible. Register. Learn how to get one now. As a network provider, you can: Verify eligibilitycheck plan status with a member's ID, full name, and date of birth. Find listings of the care providers we partner with including doctors, hospitals, pharmacies . 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. Thousands of CE credits awarded online. Our provider portal is currently unavailable. 200 Lothrop Street UPMC Health Plan and SKYGEN Product Guide. View UPMC's other Patient Portals. Message your doctor Send a private, secure message to your provider, anytime. Get the latest updates from UPMC Health Plan. Claims should be submitted using one of the methods below: Clearinghouse Submission:
Find a Doctor or Provider. Children's Health Insurance Program: UPMC for Kids (CHIP) Dental Advantage
. Visit UPMC Health Plan's homepage. First-time users can create an account by contacting their office Provider OnLine Account Administrator or by calling 1-800-937-0438. These resources, such as the Provider Manual, can assist you with administrative and practice needs. Provider OnLine Features With UPMC Health Plan's Provider OnLine, you can: UPMC Health Plan and SKYGEN Provider Manual. Claim files are transmitted using a secure FTP process that does not require data encryption prior to transmission. Your Username or Password? UPMC Vision Advantage
UPMC CCP-South Fayette. 205 Millers Run Road, Suite 300, Bridgeville, PA 15017 (Map) 724-934-3334. For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. Need Help? *Disclaimer: This online directory provides a list of UPMC Health Plan providers, and the information contained here is updated periodically. . Forgot Your health information, right at your fingertips. "January","February","March","April","May","June","July","August","September","October","November","December"); For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. View resources for medical providers, log into Provider OnLine, and get access to downloadable forms. 2022 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences. As a participating provider, you can access valuable information via Provider OnLine. We use the latest oral health technology and tools so you can feel good about flashing those pearly whites. Dental Care at UPMC Our dental experts can help you to put your best face forward. Emdeon should use payer ID 25184. For more information on dental services, view the UPMC Community HealthChoices Handbook . Not registered with UPMC Health Plan? Find out how Our Dental Benefits Advisory Team is ready to answer your call. Visit our secure website, where network providers can sign in and complete most administrative tasks. Account Login | MyUPMC Log In To Your Account Username Password Sign Up Forgot Username? 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. Login/Register. Forgot username or password?