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. UPMC Dental Advantage offers competitive rates, convenient tools, and rapid reimbursement. Register. Announcements Forgot username or password? Member Login. Online Login: UserID I forgot my user id (Members Only) : There was an error with the Pass through from your Public Website. UPMC for You Dental Advantage Please sign in to view patient eligibility, // Array of day names Electronically filed claims may be submitted in the following ways: Individual claim entry through Fri., 8 a.m. to 5 p.m. at 1-888-782-5678 or 717-988-0000 press 6 Medicare: UPMC for Life Dental Advantage (University of Pittsburgh retirees only) For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. Find listings of the care providers we partner with including doctors, hospitals, pharmacies . About the Electronic Remittance Advice Behavioral Health . How to Login? Your health information, right at your fingertips. For general assistance or inquiries regarding web portals or logins, please contact us here. Your 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. Providers submitting claims through Forgot username or password? Providers may use the standard PGP encryption process in addition to the secure FTP, if additional data security is desired. Dental . As a participating provider, you can access valuable information online by entering your user ID and password in the login box on this page. Medical Assistance: Your dedicated network manager can answer questions and keep you current on new benefits, features, and products. For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. Paper Claim Submission: Not registered with UPMC Health Plan? These clearinghouses are then responsible for reformatting these claims to meet HIPAA standards and passing the claims on to the Health Plan. Access your UPMC information in MyUPMC. Providers are able to submit claims directly without incurring clearinghouse expenses. If you need help with your account, please call 1-866-884-8579. Patients of UPMC Cole should select the UPMC Cole Connect Patient Portal. For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. Receive 24-hour access to claims and coverage information. Login/Register. Contact Our Dental Benefits Advisory Team, Join our UPMC Dental Advantage Provider Network, ONC 21st Century Cures Act Member Resource Center. Login/Register. We also treat serious dental issues to help you keep smiling. Browse doctors by specialty, procedure, service, or equipment to find the best fit for you! Browse doctors by specialty, procedure, service, or equipment to find the best fit for you! Please submit the National Provider Identifier (NPI), along with the tax ID and the provider ID as assigned by UPMC Health Plan. Submit claim forms to: Download a form for your practice, update your profile, or learn how to report fraud and abuse. 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. 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. 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! Select MyUPMC to access your UPMC health information. You also can register to join the network. The portal for all UPMC patients EXCEPT those in Central Pa. Our dental experts can help you to put your best face forward. PO Box 1600 Learn more about our plans and programs, find a dentist, or sign in to view patient eligibility, plan detail, and claims. The UPMC Presbyterian Dental Center at UPMC Montefiore offers preventive and follow-up dental care. Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. Resources for Dental Providers Vision Providers Search adult and pediatric providers and schedule appointments online. Important: Please provide your National Provider Identifier (NPI) when prompted. Federal Employees: Federal Employees Health Benefits Program (FEHB) Dental Advantage Complete testing and become certified with UPMC Health Plan. Were happy to give you more information about becoming a UPMC Dental Advantage provider. When care is coordinated, submit the referring provider NPI if available, as well as the name and UPIN. Claim files are transmitted using a secure FTP process that does not require data encryption prior to transmission. Pittsburgh, PA 15213 Need Help? View members' historical coverage information. For Providers About Contact . At this time, only PPO providers currently receiving their payments by checks will be included in this phase. UPMC Health Plan and SKYGEN Provider Manual. In order to submit EDI files directly to the Health Plan, providers must: UPMC Health Plan currently accepts dual provider identifiers. To learn how to register, watch our instructional Provider OnLine registration video. Have the ability to download and install a free Active-X secure FTP add-on. Dental Care at UPMC Our dental experts can help you to put your best face forward. Determine a patient's primary insurance coverage. These resources, such as the Provider Manual, can assist you with administrative and practice needs. So many helpful features. We apologize for this inconvenience and look forward to serving you the next time you sign in. Register. Home & Community-Based Services . For a medical emergency, call 911 or go to the nearest emergency department. Dentists in our network enjoy top-notch support that makes it easier to run a successful practice. Home & Community-Based Services . DHMO providers will have the ability to manage all payments under one experience on the Zelis platform in future phases. "January","February","March","April","May","June","July","August","September","October","November","December"); Find a UPMC health care facility close to you quickly by browsing by region. Find care with UPMC Health Plan's Provider Directory. Phone: 1-800-286-4242. 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. User Login. document.write(dayNames[now.getDay()] + ", " + monthNames[now.getMonth()] + " " + now.getDate() + ", " + year); User name: Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. I am a: Login. The provider's office can enter claims and verify if they have been accepted and are ready for adjudication. to earn CE credits without leaving the office. 205 Millers Run Road, Suite 300, Bridgeville, PA 15017 (Map) 724-934-3334. We use the latest oral health technology and tools so you can feel good about flashing those pearly whites. Serve as the provider practices primary contact with UPMC Health Plan regarding Provider OnLine security issues. Not a UPMC Central PA Portal Patient? You can follow up with additional questions to the HealthPlanEDI@upmc.edu distribution group. 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. Resources for Medical Providers Dental Providers Learn about the dental products UPMC Health Plan offers and the variety of resources available to network providers. Forgot username or password? 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^. Find care with UPMC Health Plan's Provider Directory. Browse doctors by specialty, procedure, service, or equipment to find the best fit for you! View UPMC's other Patient Portals. Login/Register. Dentistry - Find a Doctor | UPMC Need Care? Existing EFT payments set up with MetLife will remain unchanged, so no action is required on your part. Video Visit. 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. Need to schedule by phone? These claims are loaded into batches and immediately posted in preparation for adjudication. I am a: Login. Search adult and pediatric providers and schedule appointments online. DenteMax is one of the largest leasable dental PPO networks in the United States. Medical . Get an immediate response if mistakes are made submitting a claim (using HIPAA 837 forms). We offer personalized dental care at UPMC Montefiore in Pittsburgh and UPMC Cole in Coudersport and Port Allegany, Pa. Western Pa. Through MetDental, participating Dentists can view rosters, search for Explanation of Payment statements, download Facility Reference Guides, and more. UPMC Health Plan and SKYGEN Dental Provider Quick Reference Guide. Find out how to apply for Dental HMO/Managed Care Plan^. *Administered by National Vision Administrators, Join our UPMC Dental Advantage Provider Network, ONC 21st Century Cures Act Member Resource Center. I am a: Login. As a participating provider, you can access valuable information via Provider OnLine. Please be advised Zelis is the new payment solution for MetLife claim payments. the introduction of UPMC Dental Advantage. As a network dentist, youll get help with claims status, eligibility, and more. As a network provider, you can: Verify eligibilitycheck plan status with a member's ID, full name, and date of birth. plan detail, and claims. Learn about the dental products UPMC Health Plan offers and the variety of resources available to network providers. 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. 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. . Need to schedule by phone? Forgot 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. For a medical emergency, call 911 or go to the nearest emergency dept. Here you can explore resources and information about Medical Assistance coverage and benefits. Providers. UPMC Health Plan accepts electronic claims in data file transmissions. If you can't log in, contact Sales Support at 1-855-862-6515. Our provider portal is currently unavailable. If you choose this option for claims submission and you do not have a Provider OnLine account, complete this form to sign up. var now = new Date(); // Array of month Names 2023 MetLife Services and Solutions, LLC, VPoint Credentialing and Recredentialing Services. The plan is designed to encourage regular preventive care and foster open communication between patients and dentists regarding recommended treatment plans. Welcome to MetDental.com. 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. 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. To learn more, visit healthwise.org. Need to schedule by phone? 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. Have a sample 837 file exported from their billing system containing only UPMC Health Plan claims. Please use the following link to return to the UPMC Health Plan home pageUPMC Health Plan home page It requires the recipient's Practice or Billing System have the ability to automate loading of a file in the mandated format. The Act creates specific negotiation and dispute resolution protocols between payer and provider. Login to Provider Online. Find out how Our dental health team at UPMC Cole offers high-quality family dental care at affordable pricing. Search adult and pediatric providers and schedule appointments online. This portion of the UPMC Health Plan's website is strictly related to HIPAA-mandated EDI transactions. Find a Doctor or Provider. Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. View plansget vision and dental plan information prior to the member's visit. 200 Lothrop Street Our Dental Benefits Advisory Team is ready to answer your call. For Providers About Contact . As a provider-led health insurer, we have a unique appreciation for our relationships with network doctors and care providers. For more information on dental services, view the UPMC Community HealthChoices Handbook . The portal for UPMC Cole patients receiving inpatient care. Our Dental Advantage Newsletter includes the latest news and information for network providers. Emdeon should use payer ID 25184. UPMC Community HealthChoices (CHC) Dental Advantage First-time users can create an account by contacting their office Provider OnLine Account Administrator or by calling 1-800-937-0438. Pittsburgh, PA 15230-1600, Join our UPMC Dental Advantage Provider Network, ONC 21st Century Cures Act Member Resource Center. 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. Contact Us Current Members. 200 Lothrop Street Pittsburgh, PA 15213 412-647-8762 800-533-8762 Visit UPMC Health Plan's homepage. Forgot username or password? UPMC Vision Advantage Sign in ; Register . So can you. For technical questions about the UPMC Central PA Portal, contact the Help Desk Mon. UPMC Health Plan and SKYGEN Clinical Criteria effective 12/18/2022. For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. The portal for UPMC patients in Central Pa. Not registered with UPMC Health Plan? Our Provider Partner Update newsletter includes the latest news and information for network providers. For a medical emergency, call 911 or go to the nearest emergency department. First-time users can create a Provider OnLine account. Make Provider OnLine security requests to UPMC Health Plan on behalf of other staff members. Learn about and take advantage of the resources available to you as a network provider. 2023 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences, Supplemental content provided by Healthwise, Incorporated. Pittsburgh, PA 15230-1600. Interact with the Health Plan on claims issues via a messaging system. Submission of dental claims and prior authorizations, Member status and eligibility determination. . Visit our secure website, where network providers can sign in and complete most administrative tasks. UPMC Community HealthChoices Dental Allowance Request Form. var monthNames = new Array( You may search for dentists by zip code, proximity, and type on the provider search tool above for any of the dental options. UPMC Dental Advantage Medicare Special Needs Plans: UPMC for Life Complete Care Dental Advantage. Patients of UPMC Cole should select the UPMC Cole Connect Patient Portal. UPMC Vision Advantage and UPMC Vision Care* make it easy for you to give your patients high-quality vision care and preventive services. You also can register to join the network. Your Username or Password? 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 a doctor or specialist. Your place to stay in control. 2022 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences. This person will: If you have not accessed your Provider OnLine account in the past six months, your account may be disabled. 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). Emdeon should use payer ID 23281. Start Here. Dental . Provider OnLine Features With UPMC Health Plan's Provider OnLine, you can: Get the latest resources, news, and announcements from UPMC Health Plan for participating providers. Providers submitting claims through First-time users can create a Provider OnLine account. Via the Provider OnLine EDI tools, these batches can be viewed in several standard report formats. 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. Please be advised MetLife has contracted VPoint to provide credentialing and recredentialing services on MetLife's behalf. Manage claimssubmit and manage claims entirely online. Individual claim entry, known as Prelog, is available to providers with established Health Plan online accounts. How to Login? For Providers About Contact Search. Find out how to apply for the Preferred Dentist Program 2022 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences. View resources for medical providers, log into Provider OnLine, and get access to downloadable forms. Vision . Find care with UPMC Health Plan's Provider Directory. For patients of UPMC-affiliated doctors in Central Pa, select UPMC Central Pa Portal. For a medical emergency, call 911 or go to the nearest emergency dept. Thousands of CE credits awarded online. Children's Health Insurance Program: UPMC for Kids (CHIP) Dental Advantage 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. Batch file submissions The online provider search lets you find a person who provides . Pharmacy . First-time users can create an account by contacting their office Provider OnLine Account Administrator or by calling 1-800-937-0438. Message your doctor Send a private, secure message to your provider, anytime. Account Login | MyUPMC Log In To Your Account Username Password Sign Up Forgot Username? More Contact Options ; . For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. Don't have one? You can request that your account be reactivated by contacting 1-800-937-0438. Access formsfind provider manuals, plan sheets, lab program forms . Learn how to get one now. Sign in to UPMC Cole Connect Patient Portal. 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. UPMC Dental Advantage Provider Portal Visit our secure website, where network providers can sign in and complete most administrative tasks. 2022 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences. With UPMC Health Plan's Provider OnLine, you can: A provider office should appoint a staff member to serve as Security Officer. Login This application is best viewed using Internet Explorer versions 6.0 and higher Login As Provider Network Login Name Password Home Forgot Password? IN Get the latest news and information on the EFT/ERA Overview page in the resource center. 1 Childrens Hospital Drive, 4401 Penn Avenue, Floor 7, Pittsburgh, PA 15224 (Map) Children's North Ambulatory Surgery Center. Vision . Grant access to Provider OnLine to certain staff members on the provider's behalf. SIGN Your session has ended, thank you for using UPMC Health Plan OnLine. Commercial and Medicare . Paper Claim Submission: Log In to the Dental Advantage Provider Portal Announcements Get the latest updates from UPMC Health Plan. View up-to-date eligibility, PCP information, and covered benefits. If you have questions while you are completing the form, contact our Web Support Services at 1-800-937-0438. 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. Interested in joining UPMC Health Plans provider network? Thank you for being a part of the UPMC Dental Advantage/UPMC Vision Advantage network. Search adult and pediatric providers and schedule appointments online. Make an appointment 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. For member identification, submit the member's 11-digit ID number or the government-assigned identifiers for Medicare or Medical Assistance members. UPMC Health Plan and SKYGEN Product Guide. . 412-647-8762 In the meantime, if you need to verify eligibility, plan information or submit a claim, please follow the instructions below. Our provider portal solutions make business transactions fast, simple and convenient, including: Submission of dental claims and prior authorizations . Search adult and pediatric providers and schedule appointments online. Get virtual care Schedule a video visit with your regular provider. Login This application is best viewed using Internet Explorer versions 6.0 and higher Login As Provider Network Login Name Password Home Forgot Password? Dental . *Disclaimer: This online directory provides a list of UPMC Health Plan providers, and the information contained here is updated periodically. UPMC Dental Advantage offers UPMC employees two options Standard and Premium with a network of fully credentialed dentists. var year = now.getFullYear() For a medical emergency, call 911 or go to the nearest emergency department. Paper Claim Submission: Submit claim forms to: UPMC Dental Advantage PO Box 1600 Pittsburgh, PA 15230-1600 To verify eligibility and plan information, please call: Claims and pre-determinations should be submitted using one of the methods below: Clearinghouse Submission: 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. The UPMC Presbyterian Dental Center at UPMC Montefiore offers preventive and follow-up dental care. Resources for UPMC Health Plan/SKYGEN Dental Providers. Get the latest news and information about the Dental HMO/Managed Care Network^ and Products. For a medical emergency, call 911 or go to the nearest emergency department. It is important that you respond to VPoint to ensure your continued relationship with MetLife. Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. For additional information, please call SKYGEN Provider Services at 1-855-806-5193 or email providerservices@skygenusa.com. Sign in/Register I am a:MemberProviderEmployerProducer Sign In Please enter your username. Start Here. For a medical emergency, call 911 or go to the nearest emergency department. We offer personalized dental care at UPMC Montefiore in Pittsburgh and UPMC Cole in Coudersport and Port Allegany, Pa. 800-533-8762. DHMO providers will continue to receive paper checks and/or EFT payments as they do today, no action is required for DHMO payments. Someone will contact you. Claims should be submitted using one of the methods below: Clearinghouse Submission: 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. Call your provider's office or 1-800-533-8762. Welcome to UPMC for You! Get the latest updates from UPMC Health Plan. 2599 Wexford Bayne Road, Sewickley, PA 15143 (Map) 724-933-3700. Register. Forgot Password? Give us feedback on Provider OnLine. MetLife is committed to helping our providers have a smooth transition to our new enrollment solution with as little disruption as possible. var dayNames = new Array("Sunday","Monday","Tuesday","Wednesday","Thursday","Friday","Saturday"); If you forgot your User ID or need assistance, please call our Help Desk at 1-800-937-0438. Chat with a UPMC Health Plan provider service representative in real time. Need to schedule by phone? If you need assistance, please call our Help Desk at 1-800-937-0438. UPMC CCP-South Fayette. // patched for y2k bug! For a medical emergency, call 911 or go to the nearest emergency dept. Discover the advantages of joining, and learn about resources available to you as a network provider. If you forgot your user ID or need assistance, please call our Help Desk at 1-800-937-0438. Submit claim forms to: Advantage Dental Provider Portal We have moved! Read Dental Announcements Forgot Need to schedule by phone? 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. View resources for medical providers, log into Provider OnLine, and get access to downloadable forms. Password: Use billing software that allows the generation of a HIPAA-compliant 837 professional or institutional file. 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. PO Box 1600 Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. Dominion National provides dental plans and administrative services to UPMC Health Plan members and maintains an extensive selection of participating dentists. To learn how to register, watch our instructional Provider OnLine registration video. TTY: 711. 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.