205 Millers Run Road, Suite 300, Bridgeville, PA 15017 (Map) 724-934-3334. I am a: Login. Medicare Special Needs Plans: UPMC for Life Complete Care Dental Advantage. Our provider portal is currently unavailable. // Array of month Names Learn about the dental products UPMC Health Plan offers and the variety of resources available to network providers. Our provider portal solutions make business transactions fast, simple and convenient, including: Submission of dental claims and prior authorizations . 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. 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. 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. View UPMC's other Patient Portals. Provider Directory | Find Care | 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. The Act creates specific negotiation and dispute resolution protocols between payer and provider. UPMC Vision Advantage and UPMC Vision Care* make it easy for you to give your patients high-quality vision care and preventive services. UPMC CCP-South Fayette. 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. plan detail, and claims. Find care with UPMC Health Plan's Provider Directory. 200 Lothrop Street Login::. - UPMC Browse doctors by specialty, procedure, service, or equipment to find the best fit for you! Member Login. UPMC Health Plan Members | Dominion National UPMC Health Plan OnLine - Health Plan Member Login Manage claimssubmit and manage claims entirely 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. For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. UPMC Dental Advantage Provider Portal Visit our secure website, where network providers can sign in and complete most administrative tasks. Thousands of CE credits awarded online. Provider Directory | Find Care | UPMC Health Plan Register. To verify eligibility and plan information, please call: Claims and pre-determinations should be submitted using one of the methods below: Clearinghouse Submission: UPMC Community HealthChoices is one of the managed care organizations selected to provide Community HealthChoices (CHC) services in Pennsylvania to those who qualify for Medical Assistance and also qualify for Medicare or require a nursing facility level of care. through Fri., 8 a.m. to 5 p.m. at 1-888-782-5678 or 717-988-0000 press 6 DenteMax | DenteMax Dental PPO Network Forgot So can you. Pharmacy . Register. View members' historical coverage information. Find a Doctor, Specialist, or Provider | UPMC Complete testing and become certified with UPMC Health Plan. 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. Find out how to apply for the Preferred Dentist Program These clearinghouses are then responsible for reformatting these claims to meet HIPAA standards and passing the claims on to the Health Plan. As a network dentist, youll get help with claims status, eligibility, and more. Home & Community-Based Services . . Call your provider's office or 1-800-533-8762. Password: PO Box 1600 For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. Register. . Not registered with UPMC Health Plan? Find care with UPMC Health Plan's Provider Directory. For a medical emergency, call 911 or go to the nearest emergency dept. Search adult and pediatric providers and schedule appointments online. UPMC Community HealthChoices (CHC) Dental Advantage Online Login: UserID I forgot my user id (Members Only) : There was an error with the Pass through from your Public Website. Submit claim forms to: Your dedicated network manager can answer questions and keep you current on new benefits, features, and products. Find a UPMC health care facility close to you quickly by browsing by region. Children's Health Insurance Program: UPMC for Kids (CHIP) Dental Advantage Medical . Forgot username or password? Provider OnLine Features With UPMC Health Plan's Provider OnLine, you can: Our dental experts can help you to put your best face forward. Individual claim entry, known as Prelog, is available to providers with established Health Plan online accounts. For additional information, please call SKYGEN Provider Services at 1-855-806-5193 or email providerservices@skygenusa.com. 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. *Disclaimer: This online directory provides a list of UPMC Health Plan providers, and the information contained here is updated periodically. Your session has ended, thank you for using UPMC Health Plan OnLine. Sign in/Register I am a:MemberProviderEmployerProducer Sign In Please enter your username. Login/Register. Need to schedule by phone? 2022 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences. 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. UPMC Central PA Portal - Login Page 412-647-8762 Batch file submissions DenteMax is one of the largest leasable dental PPO networks in the United States. var monthNames = new Array( Thank you for being a part of the UPMC Dental Advantage/UPMC Vision Advantage network. the introduction of UPMC Dental Advantage. If you have questions while you are completing the form, contact our Web Support Services at 1-800-937-0438. 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. 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. For Providers | UPMC Community HealthChoices for a doctor or specialist. Don't have one? Download a form for your practice, update your profile, or learn how to report fraud and abuse. Patients of UPMC Cole should select the UPMC Cole Connect Patient Portal. So many helpful features. At this time, only PPO providers currently receiving their payments by checks will be included in this phase. You can follow up with additional questions to the HealthPlanEDI@upmc.edu distribution group. Grant access to Provider OnLine to certain staff members on the provider's behalf. User Login. First-time users can create a Provider OnLine account. Login This application is best viewed using Internet Explorer versions 6.0 and higher Login As Provider Network Login Name Password Home Forgot Password? to earn CE credits without leaving the office. . I am a: Login. 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. We offer personalized dental care at UPMC Montefiore in Pittsburgh and UPMC Cole in Coudersport and Port Allegany, Pa. Western Pa. View up-to-date eligibility, PCP information, and covered benefits. UPMC Community HealthChoices Dental Allowance Request Form. Resources for Dental Providers Vision Providers For a medical emergency, call 911 or go to the nearest emergency department. Login/Register. When care is coordinated, submit the referring provider NPI if available, as well as the name and UPIN. As a network provider, you can: Verify eligibilitycheck plan status with a member's ID, full name, and date of birth. 2022 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences. 800-533-8762. Not registered with UPMC Health Plan? Federal Employees: Federal Employees Health Benefits Program (FEHB) Dental Advantage Paper Claim Submission: For a medical emergency, call 911 or go to the nearest emergency department. Search adult and pediatric providers and schedule appointments online. PO Box 1600 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. As a provider-led health insurer, we have a unique appreciation for our relationships with network doctors and care providers. Home & Community-Based Services . Electronically filed claims may be submitted in the following ways: Individual claim entry Contact Us Current Members. Get the latest updates from UPMC Health Plan. I am a: Login. Your health information, right at your fingertips. 2023 MetLife Services and Solutions, LLC, VPoint Credentialing and Recredentialing Services. UPMC Dental Advantage For general assistance or inquiries regarding web portals or logins, please contact us here. Login - UPMC The online provider search lets you find a person who provides . dental care - Find a Doctor | UPMC // Array of day names You also can register to join the network. Find a Doctor or Provider - Provider Directory | Find Care | UPMC . 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. Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. var dayNames = new Array("Sunday","Monday","Tuesday","Wednesday","Thursday","Friday","Saturday"); If you forgot your user ID or need assistance, please call our Help Desk at 1-800-937-0438. For Providers About Contact . UPMC Health Plan and SKYGEN Clinical Criteria effective 12/18/2022. Welcome to MetDental.com. Vision . If you choose this option for claims submission and you do not have a Provider OnLine account, complete this form to sign up. Message your doctor Send a private, secure message to your provider, anytime. UPMC Dental Advantage offers UPMC employees two options Standard and Premium with a network of fully credentialed dentists. Pittsburgh, PA 15213 You also can register to join the network. DHMO providers will continue to receive paper checks and/or EFT payments as they do today, no action is required for DHMO payments. Video Visit. Commercial and Medicare Get virtual care Schedule a video visit with your regular provider. This person will: If you have not accessed your Provider OnLine account in the past six months, your account may be disabled. View plansget vision and dental plan information prior to the member's visit. Patients of UPMC Cole should select the UPMC Cole Connect Patient Portal. UPMC Vision Advantage Sign in to UPMC Cole Connect Patient Portal. 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. For Health Care Providers | UPMC Health Plan Behavioral Health . To learn how to register, watch our instructional Provider OnLine registration video. Serve as the provider practices primary contact with UPMC Health Plan regarding Provider OnLine security issues. Login This application is best viewed using Internet Explorer versions 6.0 and higher Login As Provider Network Login Name Password Home Forgot Password? In order to submit EDI files directly to the Health Plan, providers must: UPMC Health Plan currently accepts dual provider identifiers. To learn how to register, watch our instructional Provider OnLine registration video. For a medical emergency, call 911 or go to the nearest emergency dept. First-time users can create an account by contacting their office Provider OnLine Account Administrator or by calling 1-800-937-0438. As a participating provider, you can access valuable information online by entering your user ID and password in the login box on this page. If you need assistance, please call our Help Desk at 1-800-937-0438. MyUPMC: Connect to Your UPMC Care Online 200 Lothrop Street Pittsburgh, PA 15213 412-647-8762 800-533-8762 MetDental.com Dominion National provides dental plans and administrative services to UPMC Health Plan members and maintains an extensive selection of participating dentists. Claims should be submitted using one of the methods below: Clearinghouse Submission: Welcome to UPMC for You! *Administered by National Vision Administrators, Join our UPMC Dental Advantage Provider Network, ONC 21st Century Cures Act Member Resource Center. UPMC Health Plan and SKYGEN Product Guide. Here you can explore resources and information about Medical Assistance coverage and benefits. 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. Dental . For a medical emergency, call 911 or go to the nearest emergency department. Determine a patient's primary insurance coverage. With UPMC Health Plan's Provider OnLine, you can: A provider office should appoint a staff member to serve as Security Officer. Providers submitting claims through Login/Register. Find out how Resources for UPMC Health Plan/SKYGEN Dental Providers MetLife is committed to helping our providers have a smooth transition to our new enrollment solution with as little disruption as possible. It is important that you respond to VPoint to ensure your continued relationship with MetLife. Forgot 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. These resources, such as the Provider Manual, can assist you with administrative and practice needs. First-time users can create an account by contacting their office Provider OnLine Account Administrator or by calling 1-800-937-0438. The provider's office can enter claims and verify if they have been accepted and are ready for adjudication. Have a sample 837 file exported from their billing system containing only UPMC Health Plan claims. Need Help? PDF UPMC Dental Advantage Pittsburgh, PA 15230-1600. Please be advised Zelis is the new payment solution for MetLife claim payments. UPMC Health Plan and SKYGEN Dental Provider Quick Reference Guide. Please use the following link to return to the UPMC Health Plan home pageUPMC Health Plan home page For member identification, submit the member's 11-digit ID number or the government-assigned identifiers for Medicare or Medical Assistance members. Sign in ; Register . Provider Directory | Find Care | UPMC Health Plan Submission of dental claims and prior authorizations, Member status and eligibility determination. Access your UPMC information in MyUPMC. Emdeon should use payer ID 25184. Emdeon should use payer ID 23281. 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. Find a Doctor or Provider. It requires the recipient's Practice or Billing System have the ability to automate loading of a file in the mandated format. Resources for Medical Providers Dental Providers Learn about the dental products UPMC Health Plan offers and the variety of resources available to network providers. UPMC Health Plan and SKYGEN Provider Manual. Access formsfind provider manuals, plan sheets, lab program forms . Providers submitting claims through Your Username or Password? Need to schedule by phone? Your Username or Password? Dental . For a medical emergency, call 911 or go to the nearest emergency dept. // patched for y2k bug! Search adult and pediatric providers and schedule appointments online. Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. Medical Assistance: Watch and learn more about Provider OnLine, Appendix A COVID-19 Special Coverage and Payment Policy, NSA Negotiation Information for Providers, Provider Disclosure of Ownership and Control, Expedited Provider Appeal Certification Form, EPSDT Clinical and Operational Guidelines, Continuing Medical Education (CME) Resources, Join our UPMC Dental Advantage Provider Network, ONC 21st Century Cures Act Member Resource Center. Please submit the National Provider Identifier (NPI), along with the tax ID and the provider ID as assigned by UPMC Health Plan. Your place to stay in control. Providers. 2023 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences, Supplemental content provided by Healthwise, Incorporated. IN Our Dental Advantage Newsletter includes the latest news and information for network providers. How to Login? Have the ability to download and install a free Active-X secure FTP add-on. Interested in joining UPMC Health Plans provider network? 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. Forgot username or password? Dental . If you can't log in, contact Sales Support at 1-855-862-6515. First-time users can create a Provider OnLine account. Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. Dental Care at UPMC Our dental experts can help you to put your best face forward. Existing EFT payments set up with MetLife will remain unchanged, so no action is required on your part. You may search for dentists by zip code, proximity, and type on the provider search tool above for any of the dental options. Through MetDental, participating Dentists can view rosters, search for Explanation of Payment statements, download Facility Reference Guides, and more. 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. More Contact Options ; . These claims are loaded into batches and immediately posted in preparation for adjudication. Advantage Dental Provider Portal Search adult and pediatric providers and schedule appointments online. UPMC Health Plan accepts electronic claims in data file transmissions. Learn how to get one now. Forgot username or password? var now = new Date(); For Medical Providers | UPMC Health Plan Not a UPMC Central PA Portal Patient? 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. The portal for UPMC Cole patients receiving inpatient care. document.write(dayNames[now.getDay()] + ", " + monthNames[now.getMonth()] + " " + now.getDate() + ", " + year); User name: DHMO providers will have the ability to manage all payments under one experience on the Zelis platform in future phases. Visit our secure website, where network providers can sign in and complete most administrative tasks. Our Provider Partner Update newsletter includes the latest news and information for network providers. Dental and Vision Providers - UPMC Health Plan Dentists in our network enjoy top-notch support that makes it easier to run a successful practice. Need to schedule by phone? View resources for medical providers, log into Provider OnLine, and get access to downloadable forms. Paper Claim Submission: Submit claim forms to: UPMC Dental Advantage PO Box 1600 Pittsburgh, PA 15230-1600 UPMC for You Dental Advantage 1 Childrens Hospital Drive, 4401 Penn Avenue, Floor 7, Pittsburgh, PA 15224 (Map) Children's North Ambulatory Surgery Center. Forgot Password? Pittsburgh, PA 15230-1600, Join our UPMC Dental Advantage Provider Network, ONC 21st Century Cures Act Member Resource Center. Learn more about our plans and programs, find a dentist, or sign in to view patient eligibility, plan detail, and claims. 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.