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