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