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