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