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