Search adult and pediatric providers and schedule appointments online. Our Provider Partner Update newsletter includes the latest news and information for network providers. Resources for Dental Providers Vision Providers First-time users can create an account by contacting their office Provider OnLine Account Administrator or by calling 1-800-937-0438. Please be advised Zelis is the new payment solution for MetLife claim payments. Home & Community-Based Services . The portal for all UPMC patients EXCEPT those in Central Pa. Need Help? Login This application is best viewed using Internet Explorer versions 6.0 and higher Login As Provider Network Login Name Password Home Forgot Password? Interact with the Health Plan on claims issues via a messaging system. These clearinghouses are then responsible for reformatting these claims to meet HIPAA standards and passing the claims on to the Health Plan. 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. Someone will contact you. Find a UPMC health care facility close to you quickly by browsing by region. var now = new Date(); Medical Assistance:
Login to Provider Online. In the meantime, if you need to verify eligibility, plan information or submit a claim, please follow the instructions below. Not registered with UPMC Health Plan? Submit claim forms to:
To learn how to register, watch our instructional Provider OnLine registration video. If you have questions while you are completing the form, contact our Web Support Services at 1-800-937-0438. 2022 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences. *Administered by National Vision Administrators, Join our UPMC Dental Advantage Provider Network, ONC 21st Century Cures Act Member Resource Center. Register. Your health information, right at your fingertips. Our provider portal is currently unavailable. Emdeon should use payer ID 25184. 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. Advantage Dental Provider Portal We have moved! The portal for UPMC patients in Central Pa. How to Login? These claims are loaded into batches and immediately posted in preparation for adjudication. Get an immediate response if mistakes are made submitting a claim (using HIPAA 837 forms). Access formsfind provider manuals, plan sheets, lab program forms . Learn about the dental products UPMC Health Plan offers and the variety of resources available to network providers. PO Box 1600
Announcements UPMC Health Plan accepts electronic claims in data file transmissions. DHMO providers will have the ability to manage all payments under one experience on the Zelis platform in future phases. Need to schedule by phone? For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. DHMO providers will continue to receive paper checks and/or EFT payments as they do today, no action is required for DHMO payments. For general assistance or inquiries regarding web portals or logins, please contact us here. Welcome to UPMC for You! Search adult and pediatric providers and schedule appointments online. To learn how to register, watch our instructional Provider OnLine registration video. 2023 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences, Supplemental content provided by Healthwise, Incorporated. Access your UPMC information in MyUPMC. 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. Video Visit. 1 Childrens Hospital Drive, 4401 Penn Avenue, Floor 7, Pittsburgh, PA 15224 (Map) Children's North Ambulatory Surgery Center. First-time users can create a Provider OnLine account. 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. To learn more, visit healthwise.org. Account Login | MyUPMC Log In To Your Account Username Password Sign Up Forgot Username? Search adult and pediatric providers and schedule appointments online. UPMC Health Plan and SKYGEN Product Guide. UPMC Dental Advantage offers competitive rates, convenient tools, and rapid reimbursement. Get the latest resources, news, and announcements from UPMC Health Plan for participating providers. Pittsburgh, PA 15213 Electronically filed claims may be submitted in the following ways: Individual claim entry
Please use the following link to return to the UPMC Health Plan home pageUPMC Health Plan home page With UPMC Health Plan's Provider OnLine, you can: A provider office should appoint a staff member to serve as Security Officer. var year = now.getFullYear() Please submit the National Provider Identifier (NPI), along with the tax ID and the provider ID as assigned by UPMC Health Plan. Your dedicated network manager can answer questions and keep you current on new benefits, features, and products. Your Username or Password? If you choose this option for claims submission and you do not have a Provider OnLine account, complete this form to sign up. Log In to the Dental Advantage Provider Portal Announcements Get the latest updates from 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. 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. Not a UPMC Central PA Portal Patient? As a network provider, you can: Verify eligibilitycheck plan status with a member's ID, full name, and date of birth. So many helpful features. For a medical emergency, call 911 or go to the nearest emergency department. This person will: If you have not accessed your Provider OnLine account in the past six months, your account may be disabled. IN Find care with UPMC Health Plan's Provider Directory. For Providers About Contact . *Disclaimer: This online directory provides a list of UPMC Health Plan providers, and the information contained here is updated periodically. Claims should be submitted using one of the methods below: Clearinghouse Submission:
Grant access to Provider OnLine to certain staff members on the provider's behalf. Federal Employees: Federal Employees Health Benefits Program (FEHB) Dental Advantage
The UPMC Presbyterian Dental Center at UPMC Montefiore offers preventive and follow-up dental care. Important: Please provide your National Provider Identifier (NPI) when prompted. TTY: 711. Home & Community-Based Services . For a medical emergency, call 911 or go to the nearest emergency department. For more information on dental services, view the UPMC Community HealthChoices Handbook . 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. Visit our secure website, where network providers can sign in and complete most administrative tasks. Contact Us Current Members. Use billing software that allows the generation of a HIPAA-compliant 837 professional or institutional file. Need to schedule by phone? You also can register to join the network. Register. Browse doctors by specialty, procedure, service, or equipment to find the best fit for you! 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. The online provider search lets you find a person who provides . We also treat serious dental issues to help you keep smiling. Individual claim entry, known as Prelog, is available to providers with established Health Plan online accounts. Visit UPMC Health Plan's homepage. If you are interested in HIPAA-compliant EDI file submission, please refer to the additional set-up documents on this website. We offer personalized dental care at UPMC Montefiore in Pittsburgh and UPMC Cole in Coudersport and Port Allegany, Pa. Browse doctors by specialty, procedure, service, or equipment to find the best fit for you! Find care with UPMC Health Plan's Provider Directory. Here you can explore resources and information about Medical Assistance coverage and benefits. Via the Provider OnLine EDI tools, these batches can be viewed in several standard report formats. We use the latest oral health technology and tools so you can feel good about flashing those pearly whites. 200 Lothrop Street Pittsburgh, PA 15213 412-647-8762 800-533-8762 View up-to-date eligibility, PCP information, and covered benefits. I am a: Login. As a participating provider, you can access valuable information online by entering your user ID and password in the login box on this page. Phone: 1-800-286-4242. Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. UPMC Community HealthChoices Dental Allowance Request Form. to earn CE credits without leaving the office. User Login. If you need assistance, please call our Help Desk at 1-800-937-0438. Member Login. Submission of dental claims and prior authorizations, Member status and eligibility determination. 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 dept. Get the latest updates from UPMC Health Plan. Batch file submissions
. // Array of day names Paper Claim Submission: Submit claim forms to: UPMC Dental Advantage PO Box 1600 Pittsburgh, PA 15230-1600 As a participating provider, you can access valuable information via Provider OnLine. This portion of the UPMC Health Plan's website is strictly related to HIPAA-mandated EDI transactions. Your Username or Password? Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. I am a: Login. For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. PO Box 1600
View plansget vision and dental plan information prior to the member's visit. Dominion National provides dental plans and administrative services to UPMC Health Plan members and maintains an extensive selection of participating dentists. 800-533-8762. Claim files are transmitted using a secure FTP process that does not require data encryption prior to transmission. Interested in joining UPMC Health Plans provider network? Select MyUPMC to access your UPMC health information. Sign in ; Register . Behavioral Health . UPMC Dental Advantage offers UPMC employees two options Standard and Premium with a network of fully credentialed dentists. Login/Register. Read Dental Announcements You can follow up with additional questions to the HealthPlanEDI@upmc.edu distribution group. Find a Doctor or Provider. Medicare: UPMC for Life Dental Advantage (University of Pittsburgh retirees only)
Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. 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 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. Our dental experts can help you to put your best face forward. Our Dental Benefits Advisory Team is ready to answer your call. Dental Care at UPMC Our dental experts can help you to put your best face forward. View resources for medical providers, log into Provider OnLine, and get access to downloadable forms. If you can't log in, contact Sales Support at 1-855-862-6515. How to Login? Determine a patient's primary insurance coverage. 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. 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. For a medical emergency, call 911 or go to the nearest emergency department. Medical . Start Here. Discover the advantages of joining, and learn about resources available to you as a network provider. Forgot Password? Submit claim forms to:
Your session has ended, thank you for using UPMC Health Plan OnLine. Emdeon should use payer ID 23281. Register. Your place to stay in control. 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. Contact Our Dental Benefits Advisory Team, Join our UPMC Dental Advantage Provider Network, ONC 21st Century Cures Act Member Resource Center. Login/Register. Get the latest news and information on the EFT/ERA Overview page in the resource center. You may search for dentists by zip code, proximity, and type on the provider search tool above for any of the dental options. You also can register to join the network. It is important that you respond to VPoint to ensure your continued relationship with MetLife. 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). Have a sample 837 file exported from their billing system containing only UPMC Health Plan claims. For additional information, please call SKYGEN Provider Services at 1-855-806-5193 or email providerservices@skygenusa.com. Manage claimssubmit and manage claims entirely online. document.write(dayNames[now.getDay()] + ", " + monthNames[now.getMonth()] + " " + now.getDate() + ", " + year); User name: For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. Thank you for being a part of the UPMC Dental Advantage/UPMC Vision Advantage network. Search adult and pediatric providers and schedule appointments online. for a doctor or specialist. View members' historical coverage information. Get the latest news and information about the Dental HMO/Managed Care Network^ and Products. UPMC Health Plan and SKYGEN Clinical Criteria effective 12/18/2022. For Providers About Contact . Find listings of the care providers we partner with including doctors, hospitals, pharmacies . UPMC Vision Advantage and UPMC Vision Care* make it easy for you to give your patients high-quality vision care and preventive services. 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. Please be advised MetLife has contracted VPoint to provide credentialing and recredentialing services on MetLife's behalf. 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 in/Register I am a:MemberProviderEmployerProducer Sign In Please enter your username. Not registered with UPMC Health Plan? "January","February","March","April","May","June","July","August","September","October","November","December"); Browse doctors by specialty, procedure, service, or equipment to find the best fit for you! For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. 200 Lothrop Street 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. At this time, only PPO providers currently receiving their payments by checks will be included in this phase. For a medical emergency, call 911 or go to the nearest emergency dept. UPMC Vision Advantage
For a medical emergency, call 911 or go to the nearest emergency department. Dentists in our network enjoy top-notch support that makes it easier to run a successful practice. Our Dental Advantage Newsletter includes the latest news and information for network providers. Give us feedback on Provider OnLine. Chat with a UPMC Health Plan provider service representative in real time. For technical questions about the UPMC Central PA Portal, contact the Help Desk Mon. Don't have one? Learn more about our plans and programs, find a dentist, or sign in to view patient eligibility, plan detail, and claims. The plan is designed to encourage regular preventive care and foster open communication between patients and dentists regarding recommended treatment plans. SIGN Forgot For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. Forgot Find out how to apply for Dental HMO/Managed Care Plan^. Providers. plan detail, and claims. Password: View UPMC's other Patient Portals. Need to schedule by phone? Patients of UPMC Cole should select the UPMC Cole Connect Patient Portal. . var monthNames = new Array( 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. I am a: Login. Forgot username or password? Learn about and take advantage of the resources available to you as a network provider. Have the ability to download and install a free Active-X secure FTP add-on. Message your doctor Send a private, secure message to your provider, anytime. UPMC Health Plan and SKYGEN Provider Manual. 2022 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences. Children's Health Insurance Program: UPMC for Kids (CHIP) Dental Advantage
UPMC Health Plan and SKYGEN Dental Provider Quick Reference Guide. Advantage Dental's Home Support Office is now located at 63140 Britta Street Suite D104, Bend, Oregon 97703 We will be making a few exciting system changes over the next several weeks to help improve provider and member experience! For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. Our provider portal solutions make business transactions fast, simple and convenient, including: Submission of dental claims and prior authorizations . Forgot username or password? Paper Claim Submission:
Existing EFT payments set up with MetLife will remain unchanged, so no action is required on your part. The portal for UPMC Cole patients receiving inpatient care. Make Provider OnLine security requests to UPMC Health Plan on behalf of other staff members. About the Electronic Remittance Advice
If you need help with your account, please call 1-866-884-8579. 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 Dental Advantage
For Providers About Contact Search. Providers may use the standard PGP encryption process in addition to the secure FTP, if additional data security is desired. Thousands of CE credits awarded online. Pharmacy . For a medical emergency, call 911 or go to the nearest emergency department. Providers submitting claims through
. To verify eligibility and plan information, please call: Claims and pre-determinations should be submitted using one of the methods below: Clearinghouse Submission:
var dayNames = new Array("Sunday","Monday","Tuesday","Wednesday","Thursday","Friday","Saturday"); Start Here. So can you. UPMC Community HealthChoices (CHC) Dental Advantage
If you forgot your User ID or need assistance, please call our Help Desk at 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. Forgot username or password? Dentistry - Find a Doctor | UPMC Need Care? Were happy to give you more information about becoming a UPMC Dental Advantage provider. Provider OnLine Features With UPMC Health Plan's Provider OnLine, you can: MetLife is committed to helping our providers have a smooth transition to our new enrollment solution with as little disruption as possible. 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.
UPMC CCP-South Fayette. UPMC Dental Advantage Provider Portal Visit our secure website, where network providers can sign in and complete most administrative tasks. It requires the recipient's Practice or Billing System have the ability to automate loading of a file in the mandated format. 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^. If you forgot your user ID or need assistance, please call our Help Desk at 1-800-937-0438. 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. Pittsburgh, PA 15230-1600. Vision . The UPMC Presbyterian Dental Center at UPMC Montefiore offers preventive and follow-up dental care. These resources, such as the Provider Manual, can assist you with administrative and practice needs. Make an appointment Dental . DenteMax is one of the largest leasable dental PPO networks in the United States. 205 Millers Run Road, Suite 300, Bridgeville, PA 15017 (Map) 724-934-3334. Online Login: UserID I forgot my user id (Members Only) : There was an error with the Pass through from your Public Website. Through MetDental, participating Dentists can view rosters, search for Explanation of Payment statements, download Facility Reference Guides, and more. the introduction of UPMC Dental Advantage. Dental . 2023 MetLife Services and Solutions, LLC, VPoint Credentialing and Recredentialing Services. However, some plan providers may have been added or removed from the list (and/or contact information may have changed) since this directory was last updated. Search adult and pediatric providers and schedule appointments online. Find care with UPMC Health Plan's Provider Directory. When care is coordinated, submit the referring provider NPI if available, as well as the name and UPIN. Vision . 2022 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences. View resources for medical providers, log into Provider OnLine, and get access to downloadable forms. The provider's office can enter claims and verify if they have been accepted and are ready for adjudication. 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. We offer personalized dental care at UPMC Montefiore in Pittsburgh and UPMC Cole in Coudersport and Port Allegany, Pa. Western Pa. Login/Register. Medicare Special Needs Plans: UPMC for Life Complete Care Dental Advantage. Our dental health team at UPMC Cole offers high-quality family dental care at affordable pricing. 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. // patched for y2k bug! Forgot username or password? Paper Claim Submission:
through Fri., 8 a.m. to 5 p.m. at 1-888-782-5678 or 717-988-0000 press 6 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 apologize for this inconvenience and look forward to serving you the next time you sign in. First-time users can create a Provider OnLine account. For a medical emergency, call 911 or go to the nearest emergency dept. Dental . Welcome to MetDental.com. For member identification, submit the member's 11-digit ID number or the government-assigned identifiers for Medicare or Medical Assistance members. 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. Download a form for your practice, update your profile, or learn how to report fraud and abuse. Commercial and Medicare
412-647-8762 Complete testing and become certified with UPMC Health Plan. Learn how to get one now. Find out how Need to schedule by phone? Pittsburgh, PA 15230-1600, Join our UPMC Dental Advantage Provider Network, ONC 21st Century Cures Act Member Resource Center. Find out how to apply for the Preferred Dentist Program Serve as the provider practices primary contact with UPMC Health Plan regarding Provider OnLine security issues.
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