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

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