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For member identification, submit the member's 11-digit ID number or the government-assigned identifiers for Medicare or Medical Assistance members. Contact Us Current Members. Start Here. plan detail, and claims. UPMC Community HealthChoices (CHC) Dental Advantage For general assistance or inquiries regarding web portals or logins, please contact us here. Find care with UPMC Health Plan's Provider Directory. Find out how to apply for the Preferred Dentist Program Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. Get the latest news and information about the Dental HMO/Managed Care Network^ and Products. To learn how to register, watch our instructional Provider OnLine registration video. 2599 Wexford Bayne Road, Sewickley, PA 15143 (Map) 724-933-3700. If you can't log in, contact Sales Support at 1-855-862-6515. Forgot UPMC Dental Advantage As a network provider, you can: Verify eligibilitycheck plan status with a member's ID, full name, and date of birth. Please submit the National Provider Identifier (NPI), along with the tax ID and the provider ID as assigned by UPMC Health Plan. 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. 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. Please be advised MetLife has contracted VPoint to provide credentialing and recredentialing services on MetLife's behalf. Sign in to UPMC Cole Connect Patient Portal. Give us feedback on Provider OnLine. Home & Community-Based Services . 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. 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). . First-time users can create an account by contacting their office Provider OnLine Account Administrator or by calling 1-800-937-0438. Login This application is best viewed using Internet Explorer versions 6.0 and higher Login As Provider Network Login Name Password Home Forgot Password? Register. Grant access to Provider OnLine to certain staff members on the provider's behalf. Learn more about our plans and programs, find a dentist, or sign in to view patient eligibility, plan detail, and claims. View members' historical coverage information. 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. Resources for UPMC Health Plan/SKYGEN Dental Providers. UPMC Health Plan and SKYGEN Provider Manual. Login This application is best viewed using Internet Explorer versions 6.0 and higher Login As Provider Network Login Name Password Home Forgot Password? Search adult and pediatric providers and schedule appointments online. 200 Lothrop Street Pittsburgh, PA 15213 412-647-8762 800-533-8762 Your place to stay in control. *Disclaimer: This online directory provides a list of UPMC Health Plan providers, and the information contained here is updated periodically. Submit claim forms to: the introduction of UPMC Dental Advantage. Dominion National provides dental plans and administrative services to UPMC Health Plan members and maintains an extensive selection of participating dentists. The Act creates specific negotiation and dispute resolution protocols between payer and provider. Learn about the dental products UPMC Health Plan offers and the variety of resources available to network providers. As a provider-led health insurer, we have a unique appreciation for our relationships with network doctors and care providers. I am a: Login. Video Visit. Important: Please provide your National Provider Identifier (NPI) when prompted. Resources for Dental Providers Vision Providers For Providers About Contact . We also treat serious dental issues to help you keep smiling. Visit UPMC Health Plan's homepage. 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^. 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. You also can register to join the network. Need to schedule by phone? The portal for UPMC Cole patients receiving inpatient care. The provider's office can enter claims and verify if they have been accepted and are ready for adjudication. Account Login | MyUPMC Log In To Your Account Username Password Sign Up Forgot Username? Please sign in to view patient eligibility, Find listings of the care providers we partner with including doctors, hospitals, pharmacies . Forgot username or password? Find out how to apply for Dental HMO/Managed Care Plan^. Get the latest updates from UPMC Health Plan. Not registered with UPMC Health Plan? Get the latest news and information on the EFT/ERA Overview page in the resource center. As a participating provider, you can access valuable information online by entering your user ID and password in the login box on this page. Search adult and pediatric providers and schedule appointments online. Medicare Special Needs Plans: UPMC for Life Complete Care Dental Advantage. UPMC Vision Advantage and UPMC Vision Care* make it easy for you to give your patients high-quality vision care and preventive services. For a medical emergency, call 911 or go to the nearest emergency dept. Individual claim entry, known as Prelog, is available to providers with established Health Plan online accounts. Password: For a medical emergency, call 911 or go to the nearest emergency department. Your session has ended, thank you for using UPMC Health Plan OnLine. We offer personalized dental care at UPMC Montefiore in Pittsburgh and UPMC Cole in Coudersport and Port Allegany, Pa. 205 Millers Run Road, Suite 300, Bridgeville, PA 15017 (Map) 724-934-3334. Sign in ; Register . Providers are able to submit claims directly without incurring clearinghouse expenses. Dental Care at UPMC Our dental experts can help you to put your best face forward. Announcements through Fri., 8 a.m. to 5 p.m. at 1-888-782-5678 or 717-988-0000 press 6 Resources for Medical Providers Dental Providers Learn about the dental products UPMC Health Plan offers and the variety of resources available to network providers. Please use the following link to return to the UPMC Health Plan home pageUPMC Health Plan home page Not registered with UPMC Health Plan? UPMC for You Dental Advantage If you have questions while you are completing the form, contact our Web Support Services at 1-800-937-0438. Providers submitting claims through Forgot username or password? UPMC Health Plan and SKYGEN Dental Provider Quick Reference Guide. UPMC Dental Advantage offers UPMC employees two options Standard and Premium with a network of fully credentialed dentists. Providers may use the standard PGP encryption process in addition to the secure FTP, if additional data security is desired. Dental . Register. At this time, only PPO providers currently receiving their payments by checks will be included in this phase. 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. DHMO providers will have the ability to manage all payments under one experience on the Zelis platform in future phases. Sign in/Register I am a:MemberProviderEmployerProducer Sign In Please enter your username. . TTY: 711. Not a UPMC Central PA Portal Patient? DenteMax is one of the largest leasable dental PPO networks in the United States. I am a: Login. This portion of the UPMC Health Plan's website is strictly related to HIPAA-mandated EDI transactions. Download a form for your practice, update your profile, or learn how to report fraud and abuse. 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. UPMC Community HealthChoices Dental Allowance Request Form. You can request that your account be reactivated by contacting 1-800-937-0438. View plansget vision and dental plan information prior to the member's visit. Dental . Behavioral Health . If you choose this option for claims submission and you do not have a Provider OnLine account, complete this form to sign up. Provider OnLine Features With UPMC Health Plan's Provider OnLine, you can: 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! How to Login? Medicare: UPMC for Life Dental Advantage (University of Pittsburgh retirees only) to earn CE credits without leaving the office. . Patients of UPMC Cole should select the 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. 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. Home & Community-Based Services . 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. UPMC Health Plan and SKYGEN Clinical Criteria effective 12/18/2022. Use billing software that allows the generation of a HIPAA-compliant 837 professional or institutional file. For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. If you need assistance, please call our Help Desk at 1-800-937-0438. 2022 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences. Submit claim forms to: View up-to-date eligibility, PCP information, and covered benefits. Find care with UPMC Health Plan's Provider Directory. Need to schedule by phone? Your Username or Password? For a medical emergency, call 911 or go to the nearest emergency dept. The UPMC Presbyterian Dental Center at UPMC Montefiore offers preventive and follow-up dental care. It is important that you respond to VPoint to ensure your continued relationship with MetLife. Log In to the Dental Advantage Provider Portal Announcements Get the latest updates from UPMC Health Plan. Make Provider OnLine security requests to UPMC Health Plan on behalf of other staff members. Our provider portal is currently unavailable. Claims should be submitted using one of the methods below: Clearinghouse Submission: Paper Claim Submission: Submit claim forms to: UPMC Dental Advantage PO Box 1600 Pittsburgh, PA 15230-1600 Search adult and pediatric providers and schedule appointments online. 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. Search adult and pediatric providers and schedule appointments online. Emdeon should use payer ID 23281. Message your doctor Send a private, secure message to your provider, anytime. Have a sample 837 file exported from their billing system containing only UPMC Health Plan claims. 2022 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences. Serve as the provider practices primary contact with UPMC Health Plan regarding Provider OnLine security issues. . Forgot Password? UPMC Dental Advantage offers competitive rates, convenient tools, and rapid reimbursement. "January","February","March","April","May","June","July","August","September","October","November","December"); For Providers About Contact Search. 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. If you forgot your user ID or need assistance, please call our Help Desk at 1-800-937-0438. Search adult and pediatric providers and schedule appointments online. Someone will contact you. Children's Health Insurance Program: UPMC for Kids (CHIP) Dental Advantage First-time users can create an account by contacting their office Provider OnLine Account Administrator or by calling 1-800-937-0438. UPMC CCP-South Fayette. DHMO providers will continue to receive paper checks and/or EFT payments as they do today, no action is required for DHMO payments. Read Dental Announcements For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. Find a UPMC health care facility close to you quickly by browsing by region. Find care with UPMC Health Plan's Provider Directory. Discover the advantages of joining, and learn about resources available to you as a network provider. This person will: If you have not accessed your Provider OnLine account in the past six months, your account may be disabled. Get an immediate response if mistakes are made submitting a claim (using HIPAA 837 forms). Chat with a UPMC Health Plan provider service representative in real time. I am a: Login. As a participating provider, you can access valuable information via Provider OnLine. For a medical emergency, call 911 or go to the nearest emergency department. If you are interested in HIPAA-compliant EDI file submission, please refer to the additional set-up documents on this website. Welcome to MetDental.com. These resources, such as the Provider Manual, can assist you with administrative and practice needs. The UPMC Presbyterian Dental Center at UPMC Montefiore offers preventive and follow-up dental care. // Array of month Names 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? Login to Provider Online. Learn about and take advantage of the resources available to you as a network provider. 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. document.write(dayNames[now.getDay()] + ", " + monthNames[now.getMonth()] + " " + now.getDate() + ", " + year); User name: We offer personalized dental care at UPMC Montefiore in Pittsburgh and UPMC Cole in Coudersport and Port Allegany, Pa. Western Pa. 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. When care is coordinated, submit the referring provider NPI if available, as well as the name and UPIN. Pittsburgh, PA 15213 In the meantime, if you need to verify eligibility, plan information or submit a claim, please follow the instructions below. Providers. Interact with the Health Plan on claims issues via a messaging system. 200 Lothrop Street Get virtual care Schedule a video visit with your regular provider. 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. Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. Pharmacy . Our dental experts can help you to put your best face forward. Need to schedule by phone? Existing EFT payments set up with MetLife will remain unchanged, so no action is required on your part. Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. Determine a patient's primary insurance coverage. Dental . Pittsburgh, PA 15230-1600, Join our UPMC Dental Advantage Provider Network, ONC 21st Century Cures Act Member Resource Center. As a participating provider, you can access valuable information online by entering your user ID and password in the login box on this page. 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. Here you can explore resources and information about Medical Assistance coverage and benefits. IN Your health information, right at your fingertips. Manage claimssubmit and manage claims entirely online. 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. Phone: 1-800-286-4242. 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. Your Username or Password? For technical questions about the UPMC Central PA Portal, contact the Help Desk Mon. Electronically filed claims may be submitted in the following ways: Individual claim entry Need Help? So can you. Login/Register. You can follow up with additional questions to the HealthPlanEDI@upmc.edu distribution group. Paper Claim Submission: For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. To learn how to register, watch our instructional Provider OnLine registration video. We apologize for this inconvenience and look forward to serving you the next time you sign in. Interested in joining UPMC Health Plans provider network? Find a Doctor or Provider. 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. View resources for medical providers, log into Provider OnLine, and get access to downloadable forms. Member Login. PO Box 1600 Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. Advantage Dental Provider Portal We have moved! Contact Our Dental Benefits Advisory Team, Join our UPMC Dental Advantage Provider Network, ONC 21st Century Cures Act Member Resource Center. Welcome to UPMC for You! Select MyUPMC to access your UPMC health information. As a network dentist, youll get help with claims status, eligibility, and more. Browse doctors by specialty, procedure, service, or equipment to find the best fit for you! For more information on dental services, view the UPMC Community HealthChoices Handbook . UPMC Health Plan and SKYGEN Product Guide. User Login. Your dedicated network manager can answer questions and keep you current on new benefits, features, and products. var dayNames = new Array("Sunday","Monday","Tuesday","Wednesday","Thursday","Friday","Saturday"); 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. Vision . These claims are loaded into batches and immediately posted in preparation for adjudication. 800-533-8762. For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. Start Here. It requires the recipient's Practice or Billing System have the ability to automate loading of a file in the mandated format. PO Box 1600 Don't have one? Our Dental Benefits Advisory Team is ready to answer your call. Commercial and Medicare Learn how to get one now. Our dental health team at UPMC Cole offers high-quality family dental care at affordable pricing. Thank you for being a part of the UPMC Dental Advantage/UPMC Vision Advantage network. Forgot username or password? These clearinghouses are then responsible for reformatting these claims to meet HIPAA standards and passing the claims on to the Health Plan. 1 Childrens Hospital Drive, 4401 Penn Avenue, Floor 7, Pittsburgh, PA 15224 (Map) Children's North Ambulatory Surgery Center. var year = now.getFullYear() The online provider search lets you find a person who provides . Make an appointment 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. *Administered by National Vision Administrators, Join our UPMC Dental Advantage Provider Network, ONC 21st Century Cures Act Member Resource Center. Access your UPMC information in MyUPMC. var monthNames = new Array( For a medical emergency, call 911 or go to the nearest emergency department. You may search for dentists by zip code, proximity, and type on the provider search tool above for any of the dental options. 2023 MetLife Services and Solutions, LLC, VPoint Credentialing and Recredentialing Services. To learn more, visit healthwise.org. For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. Vision . So many helpful features. In order to submit EDI files directly to the Health Plan, providers must: UPMC Health Plan currently accepts dual provider identifiers. Thousands of CE credits awarded online. 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. If you forgot your User ID or need assistance, please call our Help Desk at 1-800-937-0438. Dentists in our network enjoy top-notch support that makes it easier to run a successful practice. Were happy to give you more information about becoming a UPMC Dental Advantage provider. Login/Register. View UPMC's other Patient Portals. Claim files are transmitted using a secure FTP process that does not require data encryption prior to transmission. Via the Provider OnLine EDI tools, these batches can be viewed in several standard report formats. Forgot Need to schedule by phone? Please be advised Zelis is the new payment solution for MetLife claim payments. You also can register to join the network. Providers submitting claims through First-time users can create a Provider OnLine account. View resources for medical providers, log into Provider OnLine, and get access to downloadable forms. Our Provider Partner Update newsletter includes the latest news and information for network providers. Emdeon should use payer ID 25184. For Providers About Contact . 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. To verify eligibility and plan information, please call: Claims and pre-determinations should be submitted using one of the methods below: Clearinghouse Submission: Dentistry - Find a Doctor | UPMC Need Care? First-time users can create a Provider OnLine account. About the Electronic Remittance Advice 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. Our provider portal solutions make business transactions fast, simple and convenient, including: Submission of dental claims and prior authorizations . For a medical emergency, call 911 or go to the nearest emergency dept. 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. Get the latest resources, news, and announcements from UPMC Health Plan for participating providers. Complete testing and become certified with UPMC Health Plan. for a doctor or specialist. MetLife is committed to helping our providers have a smooth transition to our new enrollment solution with as little disruption as possible. // Array of day names Find out how 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. Access formsfind provider manuals, plan sheets, lab program forms . Receive 24-hour access to claims and coverage information. UPMC Vision Advantage We use the latest oral health technology and tools so you can feel good about flashing those pearly whites. Call your provider's office or 1-800-533-8762. // patched for y2k bug! Pittsburgh, PA 15230-1600. Have the ability to download and install a free Active-X secure FTP add-on. The plan is designed to encourage regular preventive care and foster open communication between patients and dentists regarding recommended treatment plans. More Contact Options ; . For a medical emergency, call 911 or go to the nearest emergency department. UPMC Health Plan accepts electronic claims in data file transmissions. Login/Register. 412-647-8762 The portal for UPMC patients in Central Pa. How to Login? Browse doctors by specialty, procedure, service, or equipment to find the best fit for you! Online Login: UserID I forgot my user id (Members Only) : There was an error with the Pass through from your Public Website. 2023 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences, Supplemental content provided by Healthwise, Incorporated. Batch file submissions Our Dental Advantage Newsletter includes the latest news and information for network providers. Submission of dental claims and prior authorizations, Member status and eligibility determination. If you need help with your account, please call 1-866-884-8579. Paper Claim Submission: Federal Employees: Federal Employees Health Benefits Program (FEHB) Dental Advantage Medical . Browse doctors by specialty, procedure, service, or equipment to find the best fit for you! For nearly 30 yearsSKYGEN has been a trusted partner in a changing dental landscape, offering the tools and support you need to enhance your business while providing exceptional patient care. Through MetDental, participating Dentists can view rosters, search for Explanation of Payment statements, download Facility Reference Guides, and more. 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. SIGN 2022 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences. Register. Forgot username or password? var now = new Date(); Medical Assistance: