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