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