Forgot username or password? Your dedicated network manager can answer questions and keep you current on new benefits, features, and products. Here you can explore resources and information about Medical Assistance coverage and benefits. You can follow up with additional questions to the [email protected] distribution group. Resources for UPMC Health Plan/SKYGEN Dental Providers. Determine a patient's primary insurance coverage. If you need assistance, please call our Help Desk at 1-800-937-0438. I am a: Login. The portal for UPMC Cole patients receiving inpatient care. 1 Childrens Hospital Drive, 4401 Penn Avenue, Floor 7, Pittsburgh, PA 15224 (Map) Children's North Ambulatory Surgery Center. Through MetDental, participating Dentists can view rosters, search for Explanation of Payment statements, download Facility Reference Guides, and more. Register. Home & Community-Based Services . You may search for dentists by zip code, proximity, and type on the provider search tool above for any of the dental options. 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. Account Login | MyUPMC Log In To Your Account Username Password Sign Up Forgot Username? Dominion National provides dental plans and administrative services to UPMC Health Plan members and maintains an extensive selection of participating dentists. Find care with UPMC Health Plan's Provider Directory. As a provider-led health insurer, we have a unique appreciation for our relationships with network doctors and care providers. In the meantime, if you need to verify eligibility, plan information or submit a claim, please follow the instructions below. PO Box 1600 Learn about the dental products UPMC Health Plan offers and the variety of resources available to network providers. For member identification, submit the member's 11-digit ID number or the government-assigned identifiers for Medicare or Medical Assistance members. 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. Our Dental Advantage Newsletter includes the latest news and information for network providers. View resources for medical providers, log into Provider OnLine, and get access to downloadable forms. Dentistry - Find a Doctor | UPMC Need Care? Login/Register. Select MyUPMC to access your UPMC health information. You also can register to join the network. Welcome to MetDental.com. Medicare Special Needs Plans: UPMC for Life Complete Care Dental Advantage. UPMC Dental Advantage offers competitive rates, convenient tools, and rapid reimbursement. Give us feedback on Provider OnLine. Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. 2599 Wexford Bayne Road, Sewickley, PA 15143 (Map) 724-933-3700. Login This application is best viewed using Internet Explorer versions 6.0 and higher Login As Provider Network Login Name Password Home Forgot Password? These claims are loaded into batches and immediately posted in preparation for adjudication. For a medical emergency, call 911 or go to the nearest emergency department. Existing EFT payments set up with MetLife will remain unchanged, so no action is required on your part. With UPMC Health Plan's Provider OnLine, you can: A provider office should appoint a staff member to serve as Security Officer. Forgot To learn how to register, watch our instructional Provider OnLine registration video. 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! UPMC for You Dental Advantage For patients of UPMC-affiliated doctors in Central Pa, select UPMC Central Pa Portal. 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. As a participating provider, you can access valuable information online by entering your user ID and password in the login box on this page. Pittsburgh, PA 15213 So can you. Need Help? 800-533-8762. Sign in/Register I am a:MemberProviderEmployerProducer Sign In Please enter your username. Need to schedule by phone? Commercial and Medicare Sign in ; Register . For Providers About Contact . var year = now.getFullYear() DHMO providers will have the ability to manage all payments under one experience on the Zelis platform in future phases. Register. Start Here. Welcome to UPMC for You! // patched for y2k bug! Find care with UPMC Health Plan's Provider Directory. As a participating provider, you can access valuable information online by entering your user ID and password in the login box on this page. to earn CE credits without leaving the office. Make an appointment Someone will contact you. Medicare: UPMC for Life Dental Advantage (University of Pittsburgh retirees only) SIGN 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. Emdeon should use payer ID 25184. Chat with a UPMC Health Plan provider service representative in real time. Our dental health team at UPMC Cole offers high-quality family dental care at affordable pricing. Register. The portal for all UPMC patients EXCEPT those in Central Pa. Please sign in to view patient eligibility, Providers. Your health information, right at your fingertips. Use billing software that allows the generation of a HIPAA-compliant 837 professional or institutional file. the introduction of UPMC Dental Advantage. DHMO providers will continue to receive paper checks and/or EFT payments as they do today, no action is required for DHMO payments. For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. The online provider search lets you find a person who provides . This portion of the UPMC Health Plan's website is strictly related to HIPAA-mandated EDI transactions. First-time users can create an account by contacting their office Provider OnLine Account Administrator or by calling 1-800-937-0438. Find out how to apply for the Preferred Dentist Program Not registered with UPMC Health Plan? The plan is designed to encourage regular preventive care and foster open communication between patients and dentists regarding recommended treatment plans. 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. 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. For technical questions about the UPMC Central PA Portal, contact the Help Desk Mon. 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. UPMC Vision Advantage As a network provider, you can: Verify eligibilitycheck plan status with a member's ID, full name, and date of birth. "January","February","March","April","May","June","July","August","September","October","November","December"); For a medical emergency, call 911 or go to the nearest emergency dept. 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 general assistance or inquiries regarding web portals or logins, please contact us here. 2023 MetLife Services and Solutions, LLC, VPoint Credentialing and Recredentialing Services. Have a sample 837 file exported from their billing system containing only UPMC Health Plan claims. View up-to-date eligibility, PCP information, and covered benefits. 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 Pharmacy . Batch file submissions Our provider portal is currently unavailable. We offer personalized dental care at UPMC Montefiore in Pittsburgh and UPMC Cole in Coudersport and Port Allegany, Pa. Western Pa. 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. var monthNames = new Array( Paper Claim Submission: 2022 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences. Claims should be submitted using one of the methods below: Clearinghouse Submission: Pittsburgh, PA 15230-1600, Join our UPMC Dental Advantage Provider Network, ONC 21st Century Cures Act Member Resource Center. UPMC Health Plan and SKYGEN Product Guide. Get the latest updates from UPMC Health Plan. For a medical emergency, call 911 or go to the nearest emergency department. Find out how to apply for Dental HMO/Managed Care Plan^. How to Login? . Online Login: UserID I forgot my user id (Members Only) : There was an error with the Pass through from your Public Website. Need to schedule by phone? Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. Manage claimssubmit and manage claims entirely online. through Fri., 8 a.m. to 5 p.m. at 1-888-782-5678 or 717-988-0000 press 6 UPMC Health Plan and SKYGEN Clinical Criteria effective 12/18/2022. For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. We apologize for this inconvenience and look forward to serving you the next time you sign in. Learn how to get one now. Dental . Providers are able to submit claims directly without incurring clearinghouse expenses. It requires the recipient's Practice or Billing System have the ability to automate loading of a file in the mandated format. Message your doctor Send a private, secure message to your provider, anytime. MetLife is committed to helping our providers have a smooth transition to our new enrollment solution with as little disruption as possible. 200 Lothrop Street These resources, such as the Provider Manual, can assist you with administrative and practice needs. UPMC Health Plan and SKYGEN Provider Manual. TTY: 711. 412-647-8762 Resources for Medical Providers Dental Providers Learn about the dental products UPMC Health Plan offers and the variety of resources available to network providers. Your Username or Password? 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. For Providers About Contact Search. 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. To learn more, visit healthwise.org. Your session has ended, thank you for using UPMC Health Plan OnLine. Get virtual care Schedule a video visit with your regular provider. IN Find out how As a network dentist, youll get help with claims status, eligibility, and more. Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. 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. Resources for Dental Providers Vision Providers Our Dental Benefits Advisory Team is ready to answer your call. 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. Start Here. Find listings of the care providers we partner with including doctors, hospitals, pharmacies . Visit UPMC Health Plan's homepage. For more information on dental services, view the UPMC Community HealthChoices Handbook . UPMC Community HealthChoices Dental Allowance Request Form. Children's Health Insurance Program: UPMC for Kids (CHIP) Dental Advantage Providers submitting claims through Please be advised Zelis is the new payment solution for MetLife claim payments. Need to schedule by phone? . Find care with UPMC Health Plan's Provider Directory. Browse doctors by specialty, procedure, service, or equipment to find the best fit for you! Not a UPMC Central PA Portal Patient? Providers may use the standard PGP encryption process in addition to the secure FTP, if additional data security is desired. Make Provider OnLine security requests to UPMC Health Plan on behalf of other staff members. About the Electronic Remittance Advice Download a form for your practice, update your profile, or learn how to report fraud and abuse. User Login. Get an immediate response if mistakes are made submitting a claim (using HIPAA 837 forms). 200 Lothrop Street Pittsburgh, PA 15213 412-647-8762 800-533-8762 View resources for medical providers, log into Provider OnLine, and get access to downloadable forms. Forgot username or password? It is important that you respond to VPoint to ensure your continued relationship with MetLife. 2022 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences. Our Provider Partner Update newsletter includes the latest news and information for network providers. UPMC Dental Advantage . 2023 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences, Supplemental content provided by Healthwise, Incorporated. 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! Contact Our Dental Benefits Advisory Team, Join our UPMC Dental Advantage Provider Network, ONC 21st Century Cures Act Member Resource Center. Thank you for being a part of the UPMC Dental Advantage/UPMC Vision Advantage network. Individual claim entry, known as Prelog, is available to providers with established Health Plan online accounts. This person will: If you have not accessed your Provider OnLine account in the past six months, your account may be disabled. For additional information, please call SKYGEN Provider Services at 1-855-806-5193 or email [email protected]. var now = new Date(); Your Username or Password? The portal for UPMC patients in Central Pa. 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. For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. 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. Were happy to give you more information about becoming a UPMC Dental Advantage provider. Get the latest news and information on the EFT/ERA Overview page in the resource center. Please submit the National Provider Identifier (NPI), along with the tax ID and the provider ID as assigned by UPMC Health Plan. Via the Provider OnLine EDI tools, these batches can be viewed in several standard report formats. Need to schedule by phone? Video Visit. First-time users can create a Provider OnLine account. document.write(dayNames[now.getDay()] + ", " + monthNames[now.getMonth()] + " " + now.getDate() + ", " + year); User name: UPMC Health Plan and SKYGEN Dental Provider Quick Reference Guide. Claim files are transmitted using a secure FTP process that does not require data encryption prior to transmission. Find a Doctor or Provider. for a doctor or specialist. Get the latest resources, news, and announcements from UPMC Health Plan for participating providers. var dayNames = new Array("Sunday","Monday","Tuesday","Wednesday","Thursday","Friday","Saturday"); For a medical emergency, call 911 or go to the nearest emergency department. Have the ability to download and install a free Active-X secure FTP add-on. 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. So many helpful features. As a participating provider, you can access valuable information via Provider OnLine. Federal Employees: Federal Employees Health Benefits Program (FEHB) Dental Advantage Providers submitting claims through I am a: Login. View UPMC's other Patient Portals. 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. Member Login. Complete testing and become certified with UPMC Health Plan. For a medical emergency, call 911 or go to the nearest emergency dept. Please be advised MetLife has contracted VPoint to provide credentialing and recredentialing services on MetLife's behalf. Vision . For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. Discover the advantages of joining, and learn about resources available to you as a network provider. Search adult and pediatric providers and schedule appointments online. At this time, only PPO providers currently receiving their payments by checks will be included in this phase. 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. Patients of UPMC Cole should select the UPMC Cole Connect Patient Portal. Interact with the Health Plan on claims issues via a messaging system. Patients of UPMC Cole should select the UPMC Cole Connect Patient Portal. // Array of day names UPMC Community HealthChoices (CHC) Dental Advantage You can request that your account be reactivated by contacting 1-800-937-0438. UPMC CCP-South Fayette. Call your provider's office or 1-800-533-8762. If you can't log in, contact Sales Support at 1-855-862-6515. Dentists in our network enjoy top-notch support that makes it easier to run a successful practice. If you are interested in HIPAA-compliant EDI file submission, please refer to the additional set-up documents on this website. Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. Forgot username or password? How to Login? Phone: 1-800-286-4242. 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 [email protected]. plan detail, and claims. Login/Register. For Providers About Contact . Get the latest news and information about the Dental HMO/Managed Care Network^ and Products. Thousands of CE credits awarded online. Dental . // Array of month Names Medical Assistance: Electronically filed claims may be submitted in the following ways: Individual claim entry PO Box 1600 Find a UPMC health care facility close to you quickly by browsing by region. Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. Our provider portal solutions make business transactions fast, simple and convenient, including: Submission of dental claims and prior authorizations . Grant access to Provider OnLine to certain staff members on the provider's behalf. The UPMC Presbyterian Dental Center at UPMC Montefiore offers preventive and follow-up dental care. For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. *Disclaimer: This online directory provides a list of UPMC Health Plan providers, and the information contained here is updated periodically. Dental . Important: Please provide your National Provider Identifier (NPI) when prompted. These clearinghouses are then responsible for reformatting these claims to meet HIPAA standards and passing the claims on to the Health Plan. The provider's office can enter claims and verify if they have been accepted and are ready for adjudication. Pittsburgh, PA 15230-1600. If you choose this option for claims submission and you do not have a Provider OnLine account, complete this form to sign up. Browse doctors by specialty, procedure, service, or equipment to find the best fit for you! Login/Register. UPMC Dental Advantage offers UPMC employees two options Standard and Premium with a network of fully credentialed dentists. In order to submit EDI files directly to the Health Plan, providers must: UPMC Health Plan currently accepts dual provider identifiers. For help utilizing the provider web portal, registering, or requesting training, contact SKYGEN's Portal Services Team at [email protected] or call 1-844-621-4576. 205 Millers Run Road, Suite 300, Bridgeville, PA 15017 (Map) 724-934-3334. Need to schedule by phone? Password: Learn about and take advantage of the resources available to you as a network provider. Submit claim forms to: 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. Not registered with UPMC Health Plan? *Administered by National Vision Administrators, Join our UPMC Dental Advantage Provider Network, ONC 21st Century Cures Act Member Resource Center. Your place to stay in control. Search adult and pediatric providers and schedule appointments online. The Act creates specific negotiation and dispute resolution protocols between payer and provider. Medical . Learn more about our plans and programs, find a dentist, or sign in to view patient eligibility, plan detail, and claims. You also can register to join the network. Forgot Password? When care is coordinated, submit the referring provider NPI if available, as well as the name and UPIN. We also treat serious dental issues to help you keep smiling. DenteMax is one of the largest leasable dental PPO networks in the United States. Visit our secure website, where network providers can sign in and complete most administrative tasks. First-time users can create an account by contacting their office Provider OnLine Account Administrator or by calling 1-800-937-0438. Read Dental Announcements View members' historical coverage information. Login This application is best viewed using Internet Explorer versions 6.0 and higher Login As Provider Network Login Name Password Home Forgot Password? Receive 24-hour access to claims and coverage information. 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. If you have questions while you are completing the form, contact our Web Support Services at 1-800-937-0438. For a medical emergency, call 911 or go to the nearest emergency department. First-time users can create a Provider OnLine account. Home & Community-Based Services . 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. To verify eligibility and plan information, please call: Claims and pre-determinations should be submitted using one of the methods below: Clearinghouse Submission: Access formsfind provider manuals, plan sheets, lab program forms . If you forgot your User ID or need assistance, please call our Help Desk at 1-800-937-0438. View plansget vision and dental plan information prior to the member's visit. Paper Claim Submission: Advantage Dental Provider Portal We have moved! Announcements For a medical emergency, call 911 or go to the nearest emergency dept. Please use the following link to return to the UPMC Health Plan home pageUPMC Health Plan home page For a medical emergency, call 911 or go to the nearest emergency department. Access your UPMC information in MyUPMC. Vision . Login to Provider Online. UPMC Vision Advantage and UPMC Vision Care* make it easy for you to give your patients high-quality vision care and preventive services. Log In to the Dental Advantage Provider Portal Announcements Get the latest updates from UPMC Health Plan. Sign in to UPMC Cole Connect Patient Portal. 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^. Serve as the provider practices primary contact with UPMC Health Plan regarding Provider OnLine security issues. Forgot If you need help with your account, please call 1-866-884-8579. Behavioral Health . To learn how to register, watch our instructional Provider OnLine registration video. Provider OnLine Features With UPMC Health Plan's Provider OnLine, you can: More Contact Options ; . 2022 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences. UPMC Dental Advantage Provider Portal Visit our secure website, where network providers can sign in and complete most administrative tasks. If you forgot your user ID or need assistance, please call our Help Desk at 1-800-937-0438. Forgot username or password? Submit claim forms to: . UPMC Health Plan accepts electronic claims in data file transmissions. I am a: 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). Dental Care at UPMC Our dental experts can help you to put your best face forward. We use the latest oral health technology and tools so you can feel good about flashing those pearly whites. Submission of dental claims and prior authorizations, Member status and eligibility determination. Our dental experts can help you to put your best face forward. Contact Us Current Members. Don't have one? 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. Interested in joining UPMC Health Plans provider network? Search adult and pediatric providers and schedule appointments online. Emdeon should use payer ID 23281.