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