We apologize for this inconvenience and look forward to serving you the next time you sign in. More Contact Options ; . Browse doctors by specialty, procedure, service, or equipment to find the best fit for you! Resources for Dental Providers Vision Providers Thousands of CE credits awarded online. The portal for all UPMC patients EXCEPT those in Central Pa. // Array of day names Dental . Your dedicated network manager can answer questions and keep you current on new benefits, features, and products. Browse doctors by specialty, procedure, service, or equipment to find the best fit for you! Serve as the provider practices primary contact with UPMC Health Plan regarding Provider OnLine security issues. *Disclaimer: This online directory provides a list of UPMC Health Plan providers, and the information contained here is updated periodically. Need to schedule by phone? Log In to the Dental Advantage Provider Portal Announcements Get the latest updates from UPMC Health Plan. Phone: 1-800-286-4242. 2023 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences, Supplemental content provided by Healthwise, Incorporated. var now = new Date(); PO Box 1600
I am a: Login. Vision . 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. Start Here. Sign in ; Register . var dayNames = new Array("Sunday","Monday","Tuesday","Wednesday","Thursday","Friday","Saturday"); Thank you for being a part of the UPMC Dental Advantage/UPMC Vision Advantage network. You can follow up with additional questions to the HealthPlanEDI@upmc.edu distribution group. For a medical emergency, call 911 or go to the nearest emergency dept. So many helpful features. Search adult and pediatric providers and schedule appointments online. Need to schedule by phone? Dentistry - Find a Doctor | UPMC Need Care? Your Username or Password? Not registered with UPMC Health Plan? Register. For a medical emergency, call 911 or go to the nearest emergency department. View plansget vision and dental plan information prior to the member's visit. Read Dental Announcements 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. Have a sample 837 file exported from their billing system containing only UPMC Health Plan claims. Through MetDental, participating Dentists can view rosters, search for Explanation of Payment statements, download Facility Reference Guides, and more. Find care with UPMC Health Plan's Provider Directory. Emdeon should use payer ID 23281. For patients of UPMC-affiliated doctors in Central Pa, select UPMC Central Pa Portal. Interested in joining UPMC Health Plans provider network? Get the latest updates from UPMC Health Plan. Get the latest news and information about the Dental HMO/Managed Care Network^ and Products. The plan is designed to encourage regular preventive care and foster open communication between patients and dentists regarding recommended treatment plans. Please be advised Zelis is the new payment solution for MetLife claim payments. UPMC Dental Advantage offers UPMC employees two options Standard and Premium with a network of fully credentialed dentists. If you can't log in, contact Sales Support at 1-855-862-6515. . Providers may use the standard PGP encryption process in addition to the secure FTP, if additional data security is desired. Get the latest resources, news, and announcements from UPMC Health Plan for participating providers. In the meantime, if you need to verify eligibility, plan information or submit a claim, please follow the instructions below. In order to submit EDI files directly to the Health Plan, providers must: UPMC Health Plan currently accepts dual provider identifiers. *Administered by National Vision Administrators, Join our UPMC Dental Advantage Provider Network, ONC 21st Century Cures Act Member Resource Center. I am a: Login. Pittsburgh, PA 15230-1600, Join our UPMC Dental Advantage Provider Network, ONC 21st Century Cures Act Member Resource Center. Our Dental Advantage Newsletter includes the latest news and information for network providers. Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. Paper Claim Submission: Submit claim forms to: UPMC Dental Advantage PO Box 1600 Pittsburgh, PA 15230-1600 As a provider-led health insurer, we have a unique appreciation for our relationships with network doctors and care providers. 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^. 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. At this time, only PPO providers currently receiving their payments by checks will be included in this phase. 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. For general assistance or inquiries regarding web portals or logins, please contact us here. UPMC Vision Advantage
Find a Doctor or Provider. How to Login? Login/Register. Video Visit. Member Login. 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. Submit claim forms to:
Via the Provider OnLine EDI tools, these batches can be viewed in several standard report formats. Forgot Access your UPMC information in MyUPMC. For member identification, submit the member's 11-digit ID number or the government-assigned identifiers for Medicare or Medical Assistance members. Welcome to MetDental.com. 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. If you need help with your account, please call 1-866-884-8579. Our provider portal is currently unavailable. Browse doctors by specialty, procedure, service, or equipment to find the best fit for you! UPMC Community HealthChoices Dental Allowance Request Form. 2023 MetLife Services and Solutions, LLC, VPoint Credentialing and Recredentialing Services. UPMC Health Plan and SKYGEN Provider Manual. the introduction of UPMC Dental Advantage. The portal for UPMC Cole patients receiving inpatient care. UPMC Dental Advantage Provider Portal Visit our secure website, where network providers can sign in and complete most administrative tasks. Find out how to apply for Dental HMO/Managed Care Plan^. It is important that you respond to VPoint to ensure your continued relationship with MetLife. If you need assistance, please call our Help Desk at 1-800-937-0438. Electronically filed claims may be submitted in the following ways: Individual claim entry
Existing EFT payments set up with MetLife will remain unchanged, so no action is required on your part. Register. We use the latest oral health technology and tools so you can feel good about flashing those pearly whites. If you are interested in HIPAA-compliant EDI file submission, please refer to the additional set-up documents on this website. As a network provider, you can: Verify eligibilitycheck plan status with a member's ID, full name, and date of birth. UPMC Dental Advantage offers competitive rates, convenient tools, and rapid reimbursement. Login This application is best viewed using Internet Explorer versions 6.0 and higher Login As Provider Network Login Name Password Home Forgot Password? 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. 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. PO Box 1600
It requires the recipient's Practice or Billing System have the ability to automate loading of a file in the mandated format. Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. Download a form for your practice, update your profile, or learn how to report fraud and abuse. 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! UPMC Health Plan and SKYGEN Product Guide. Providers.
Forgot username or password? View resources for medical providers, log into Provider OnLine, and get access to downloadable forms. For a medical emergency, call 911 or go to the nearest emergency dept. UPMC Community HealthChoices (CHC) Dental Advantage
Dominion National provides dental plans and administrative services to UPMC Health Plan members and maintains an extensive selection of participating dentists. Not registered with UPMC Health Plan? . These resources, such as the Provider Manual, can assist you with administrative and practice needs. To learn how to register, watch our instructional Provider OnLine registration video. Learn about the dental products UPMC Health Plan offers and the variety of resources available to network providers. Dental Care at UPMC Our dental experts can help you to put your best face forward. Login This application is best viewed using Internet Explorer versions 6.0 and higher Login As Provider Network Login Name Password Home Forgot Password? Online Login: UserID I forgot my user id (Members Only) : There was an error with the Pass through from your Public Website. 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. Account Login | MyUPMC Log In To Your Account Username Password Sign Up Forgot Username? These claims are loaded into batches and immediately posted in preparation for adjudication. Get the latest news and information on the EFT/ERA Overview page in the resource center. For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. Pittsburgh, PA 15230-1600. Find out how to apply for the Preferred Dentist Program Give us feedback on Provider OnLine. 205 Millers Run Road, Suite 300, Bridgeville, PA 15017 (Map) 724-934-3334. For a medical emergency, call 911 or go to the nearest emergency dept. 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. For a medical emergency, call 911 or go to the nearest emergency department. Your Username or Password? Commercial and Medicare
Don't have one? 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. var monthNames = new Array( document.write(dayNames[now.getDay()] + ", " + monthNames[now.getMonth()] + " " + now.getDate() + ", " + year); User name: First-time users can create an account by contacting their office Provider OnLine Account Administrator or by calling 1-800-937-0438. Paper Claim Submission:
You also can register to join the network. 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. For a medical emergency, call 911 or go to the nearest emergency department. Learn how to get one now. You can request that your account be reactivated by contacting 1-800-937-0438. Search adult and pediatric providers and schedule appointments online. 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. For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. To verify eligibility and plan information, please call: Claims and pre-determinations should be submitted using one of the methods below: Clearinghouse Submission:
SIGN UPMC Dental Advantage
1 Childrens Hospital Drive, 4401 Penn Avenue, Floor 7, Pittsburgh, PA 15224 (Map) Children's North Ambulatory Surgery Center. We offer personalized dental care at UPMC Montefiore in Pittsburgh and UPMC Cole in Coudersport and Port Allegany, Pa. Western Pa. Dental . Have the ability to download and install a free Active-X secure FTP add-on. As a network dentist, youll get help with claims status, eligibility, and more. About the Electronic Remittance Advice
To learn how to register, watch our instructional Provider OnLine registration video. This person will: If you have not accessed your Provider OnLine account in the past six months, your account may be disabled. Find listings of the care providers we partner with including doctors, hospitals, pharmacies . 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. Get an immediate response if mistakes are made submitting a claim (using HIPAA 837 forms). Visit UPMC Health Plan's homepage. Login to Provider Online. Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. Were happy to give you more information about becoming a UPMC Dental Advantage provider. var year = now.getFullYear() When care is coordinated, submit the referring provider NPI if available, as well as the name and UPIN. 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. View members' historical coverage information. Need to schedule by phone? DHMO providers will have the ability to manage all payments under one experience on the Zelis platform in future phases. 800-533-8762. If you choose this option for claims submission and you do not have a Provider OnLine account, complete this form to sign up. Find care with UPMC Health Plan's Provider Directory. 200 Lothrop Street Pittsburgh, PA 15213 412-647-8762 800-533-8762 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. 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. Resources for UPMC Health Plan/SKYGEN Dental Providers. Receive 24-hour access to claims and coverage information. . through Fri., 8 a.m. to 5 p.m. at 1-888-782-5678 or 717-988-0000 press 6 You also can register to join the network. We offer personalized dental care at UPMC Montefiore in Pittsburgh and UPMC Cole in Coudersport and Port Allegany, Pa. TTY: 711. Message your doctor Send a private, secure message to your provider, anytime. 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. Providers are able to submit claims directly without incurring clearinghouse expenses. 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. Need to schedule by phone? Behavioral Health . Announcements Call your provider's office or 1-800-533-8762. If you forgot your user ID or need assistance, please call our Help Desk at 1-800-937-0438. DenteMax is one of the largest leasable dental PPO networks in the United States. Our dental health team at UPMC Cole offers high-quality family dental care at affordable pricing. Login/Register. For more information on dental services, view the UPMC Community HealthChoices Handbook . 2022 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences. Find out how 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. Learn about and take advantage of the resources available to you as a network provider. Forgot username or password? Emdeon should use payer ID 25184. To learn more, visit healthwise.org. Important: Please provide your National Provider Identifier (NPI) when prompted. Need Help? 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 immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. UPMC Health Plan and SKYGEN Dental Provider Quick Reference Guide. Password: User Login. We also treat serious dental issues to help you keep smiling. As a participating provider, you can access valuable information via Provider OnLine. IN Chat with a UPMC Health Plan provider service representative in real time. 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. Use billing software that allows the generation of a HIPAA-compliant 837 professional or institutional file. Our Dental Benefits Advisory Team is ready to answer your call. to earn CE credits without leaving the office. UPMC Health Plan and SKYGEN Clinical Criteria effective 12/18/2022. Our provider portal solutions make business transactions fast, simple and convenient, including: Submission of dental claims and prior authorizations . 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. Interact with the Health Plan on claims issues via a messaging system. UPMC Health Plan accepts electronic claims in data file transmissions. If you forgot your User ID or need assistance, please call our Help Desk at 1-800-937-0438. Your session has ended, thank you for using UPMC Health Plan OnLine. "January","February","March","April","May","June","July","August","September","October","November","December"); Vision . Dental . Dentists in our network enjoy top-notch support that makes it easier to run a successful practice. 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. for a doctor or specialist. For Providers About Contact . Federal Employees: Federal Employees Health Benefits Program (FEHB) Dental Advantage
Pharmacy . First-time users can create a Provider OnLine account. So can you. Discover the advantages of joining, and learn about resources available to you as a network 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. Visit our secure website, where network providers can sign in and complete most administrative tasks. View resources for medical providers, log into Provider OnLine, and get access to downloadable forms. UPMC CCP-South Fayette. 2022 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences. For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. The portal for UPMC patients in Central Pa. Please sign in to view patient eligibility, Complete testing and become certified with UPMC Health Plan. Not a UPMC Central PA Portal Patient? Submission of dental claims and prior authorizations, Member status and eligibility determination. Login/Register. Determine a patient's primary insurance coverage. UPMC for You Dental Advantage
Sign in to UPMC Cole Connect Patient Portal. Start Here. 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 provider's office can enter claims and verify if they have been accepted and are ready for adjudication. Providers submitting claims through
Batch file submissions
Manage claimssubmit and manage claims entirely online. For a medical emergency, call 911 or go to the nearest emergency department. Provider OnLine Features With UPMC Health Plan's Provider OnLine, you can: Make an appointment Medical Assistance:
// Array of month Names Medical . Advantage Dental Provider Portal We have moved! Register. 2599 Wexford Bayne Road, Sewickley, PA 15143 (Map) 724-933-3700. Your health information, right at your fingertips. Grant access to Provider OnLine to certain staff members on the provider's behalf. Individual claim entry, known as Prelog, is available to providers with established Health Plan online accounts. The UPMC Presbyterian Dental Center at UPMC Montefiore offers preventive and follow-up dental care. Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. Someone will contact you. Children's Health Insurance Program: UPMC for Kids (CHIP) Dental Advantage
If you have questions while you are completing the form, contact our Web Support Services at 1-800-937-0438. I am a: Login. Paper Claim Submission:
How to Login? Forgot First-time users can create an account by contacting their office Provider OnLine Account Administrator or by calling 1-800-937-0438. Home & Community-Based Services . Medicare: UPMC for Life Dental Advantage (University of Pittsburgh retirees only)
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. For additional information, please call SKYGEN Provider Services at 1-855-806-5193 or email providerservices@skygenusa.com. Pittsburgh, PA 15213 Get virtual care Schedule a video visit with your regular provider. Contact Our Dental Benefits Advisory Team, Join our UPMC Dental Advantage Provider Network, ONC 21st Century Cures Act Member Resource Center. This portion of the UPMC Health Plan's website is strictly related to HIPAA-mandated EDI transactions. With UPMC Health Plan's Provider OnLine, you can: A provider office should appoint a staff member to serve as Security Officer. The online provider search lets you find a person who provides . UPMC Vision Advantage and UPMC Vision Care* make it easy for you to give your patients high-quality vision care and preventive services. Contact Us Current Members. plan detail, and claims. Here you can explore resources and information about Medical Assistance coverage and benefits. Access formsfind provider manuals, plan sheets, lab program forms . 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. These clearinghouses are then responsible for reformatting these claims to meet HIPAA standards and passing the claims on to the Health Plan. 2022 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences. Find care with UPMC Health Plan's Provider Directory. Medicare Special Needs Plans: UPMC for Life Complete Care Dental Advantage. 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 place to stay in control. Claim files are transmitted using a secure FTP process that does not require data encryption prior to transmission. Please use the following link to return to the UPMC Health Plan home pageUPMC Health Plan home page 200 Lothrop Street For a medical emergency, call 911 or go to the nearest emergency department. Learn more about our plans and programs, find a dentist, or sign in to view patient eligibility, plan detail, and claims. View up-to-date eligibility, PCP information, and covered benefits. 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 immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. First-time users can create a Provider OnLine account. Submit claim forms to:
For Providers About Contact . // patched for y2k bug! View UPMC's other Patient Portals. Select MyUPMC to access your UPMC health information. For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. Our Provider Partner Update newsletter includes the latest news and information for network providers. Please submit the National Provider Identifier (NPI), along with the tax ID and the provider ID as assigned by UPMC Health Plan. Home & Community-Based Services . The UPMC Presbyterian Dental Center at UPMC Montefiore offers preventive and follow-up dental care. . Providers submitting claims through
Need to schedule by phone? Search adult and pediatric providers and schedule appointments online. You may search for dentists by zip code, proximity, and type on the provider search tool above for any of the dental options. Patients of UPMC Cole should select the UPMC Cole Connect Patient Portal. Sign in/Register I am a:MemberProviderEmployerProducer Sign In Please enter your username. Forgot username or password? Please be advised MetLife has contracted VPoint to provide credentialing and recredentialing services on MetLife's behalf. Forgot username or password? Make Provider OnLine security requests to UPMC Health Plan on behalf of other staff members. For Providers About Contact Search. Forgot Password? Find a UPMC health care facility close to you quickly by browsing by region. 412-647-8762 Patients of UPMC Cole should select the UPMC Cole Connect Patient Portal. DHMO providers will continue to receive paper checks and/or EFT payments as they do today, no action is required for DHMO payments. Welcome to UPMC for You! Search adult and pediatric providers and schedule appointments online.