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