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