Browse doctors by specialty, procedure, service, or equipment to find the best fit for you! 205 Millers Run Road, Suite 300, Bridgeville, PA 15017 (Map) 724-934-3334. Claims should be submitted using one of the methods below: Clearinghouse Submission: 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. Serve as the provider practices primary contact with UPMC Health Plan regarding Provider OnLine security issues. UPMC Health Plan accepts electronic claims in data file transmissions. User Login. Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. I am a: Login. For Providers About Contact . Chat with a UPMC Health Plan provider service representative in real time. You can request that your account be reactivated by contacting 1-800-937-0438. These clearinghouses are then responsible for reformatting these claims to meet HIPAA standards and passing the claims on to the Health Plan. 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. to earn CE credits without leaving the office. Important: Please provide your National Provider Identifier (NPI) when prompted. 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. Member Login. Register. DenteMax is one of the largest leasable dental PPO networks in the United States. Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. Here you can explore resources and information about Medical Assistance coverage and benefits. If you forgot your User ID or need assistance, please call our Help Desk at 1-800-937-0438. MetLife is committed to helping our providers have a smooth transition to our new enrollment solution with as little disruption as possible. DHMO providers will have the ability to manage all payments under one experience on the Zelis platform in future phases. Your health information, right at your fingertips. Online Login: UserID I forgot my user id (Members Only) : There was an error with the Pass through from your Public Website. MyUPMC: Connect to Your UPMC Care Online 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. Please be advised MetLife has contracted VPoint to provide credentialing and recredentialing services on MetLife's behalf. Interested in joining UPMC Health Plans provider network? Dental . You also can register to join the network. You also can register to join the network. Dominion National provides dental plans and administrative services to UPMC Health Plan members and maintains an extensive selection of participating dentists. Our Dental Benefits Advisory Team is ready to answer your call. Need to schedule by phone? Claim files are transmitted using a secure FTP process that does not require data encryption prior to transmission. 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. Not registered with UPMC Health Plan? 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. Pittsburgh, PA 15213 for a doctor or specialist. Resources for Medical Providers Dental Providers Learn about the dental products UPMC Health Plan offers and the variety of resources available to network providers. View up-to-date eligibility, PCP information, and covered benefits. Your dedicated network manager can answer questions and keep you current on new benefits, features, and products. Sign in ; Register . Sign in/Register I am a:MemberProviderEmployerProducer Sign In Please enter your username. Use billing software that allows the generation of a HIPAA-compliant 837 professional or institutional file. Through MetDental, participating Dentists can view rosters, search for Explanation of Payment statements, download Facility Reference Guides, and more. Dental Care at UPMC 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. var dayNames = new Array("Sunday","Monday","Tuesday","Wednesday","Thursday","Friday","Saturday"); Make an appointment For member identification, submit the member's 11-digit ID number or the government-assigned identifiers for Medicare or Medical Assistance members. UPMC Vision Advantage dental care - Find a Doctor | UPMC Patients of UPMC Cole should select the UPMC Cole Connect Patient Portal. In order to submit EDI files directly to the Health Plan, providers must: UPMC Health Plan currently accepts dual provider identifiers. Message your doctor Send a private, secure message to your provider, anytime. Our provider portal is currently unavailable. For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. Thousands of CE credits awarded online. Providers Home - Avesis Vision . When care is coordinated, submit the referring provider NPI if available, as well as the name and UPIN. 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. Login/Register. UPMC for You Dental Advantage UPMC Community HealthChoices (CHC) Dental Advantage 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. Browse doctors by specialty, procedure, service, or equipment to find the best fit for you! If you have questions while you are completing the form, contact our Web Support Services at 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. Provider OnLine | UPMC Health Plan UPMC Health Plan and SKYGEN Clinical Criteria effective 12/18/2022. View UPMC's other Patient Portals. Announcements First-time users can create an account by contacting their office Provider OnLine Account Administrator or by calling 1-800-937-0438. Welcome to UPMC for You! Batch file submissions Your Username or Password? MyUPMC: Connect to Your UPMC Care Online Start Here. Have the ability to download and install a free Active-X secure FTP add-on. Call your provider's office or 1-800-533-8762. Submit claim forms to: View resources for medical providers, log into Provider OnLine, and get access to downloadable forms. 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. For a medical emergency, call 911 or go to the nearest emergency department. Behavioral Health . If you need assistance, please call our Help Desk at 1-800-937-0438. *Disclaimer: This online directory provides a list of UPMC Health Plan providers, and the information contained here is updated periodically. Login This application is best viewed using Internet Explorer versions 6.0 and higher Login As Provider Network Login Name Password Home Forgot Password? Find a Doctor or Provider - Provider Directory | Find Care | UPMC While UPMC does offer the option to generate 835 formatted ERA files (and make them available for direct download via this website) many automated billing systems interface with payers via a clearinghouse. Dental Providers | SKYGEN Get the latest news and information on the EFT/ERA Overview page in the resource center. Need to schedule by phone? So many helpful features. At this time, only PPO providers currently receiving their payments by checks will be included in this phase. Phone: 1-800-286-4242. Search adult and pediatric providers and schedule appointments online. Vision . Providers submitting claims through UPMC Vision Advantage and UPMC Vision Care* make it easy for you to give your patients high-quality vision care and preventive services. Forgot username or password? You may search for dentists by zip code, proximity, and type on the provider search tool above for any of the dental options. Dentistry - Find a Doctor | UPMC Find care with UPMC Health Plan's Provider Directory. For additional information, please call SKYGEN Provider Services at 1-855-806-5193 or email providerservices@skygenusa.com. Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. Emdeon should use payer ID 25184. Submission of dental claims and prior authorizations, Member status and eligibility determination. 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. Visit UPMC Health Plan's homepage. Learn about the dental products UPMC Health Plan offers and the variety of resources available to network providers. DenteMax | DenteMax Dental PPO Network The provider's office can enter claims and verify if they have been accepted and are ready for adjudication. For general assistance or inquiries regarding web portals or logins, please contact us here. Medicare: UPMC for Life Dental Advantage (University of Pittsburgh retirees only) IN 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. 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. Get the latest resources, news, and announcements from UPMC Health Plan for participating providers. 2599 Wexford Bayne Road, Sewickley, PA 15143 (Map) 724-933-3700. plan detail, and claims. For Providers About Contact Search. . Find a UPMC health care facility close to you quickly by browsing by region. 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. 2022 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences. . It requires the recipient's Practice or Billing System have the ability to automate loading of a file in the mandated format. Video Visit. Find out how to apply for Dental HMO/Managed Care Plan^. MetDental.com 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. Our Provider Partner Update newsletter includes the latest news and information for network providers. Get the latest news and information about the Dental HMO/Managed Care Network^ and Products. As a participating provider, you can access valuable information online by entering your user ID and password in the login box on this page. SIGN Visit our secure website, where network providers can sign in and complete most administrative tasks. As a participating provider, you can access valuable information online by entering your user ID and password in the login box on this page. Make Provider OnLine security requests to UPMC Health Plan on behalf of other staff members. UPMC Dental Advantage offers UPMC employees two options Standard and Premium with a network of fully credentialed dentists. Please be advised Zelis is the new payment solution for MetLife claim payments. Pharmacy . 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. UPMC Health Plan Members | Dominion National Get the latest updates from UPMC Health Plan. To verify eligibility and plan information, please call: Claims and pre-determinations should be submitted using one of the methods below: Clearinghouse Submission: 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! Search adult and pediatric providers and schedule appointments online. 2023 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences, Supplemental content provided by Healthwise, Incorporated. "January","February","March","April","May","June","July","August","September","October","November","December"); . 200 Lothrop Street Pittsburgh, PA 15213 412-647-8762 800-533-8762 Learn about and take advantage of the resources available to you as a network provider. Password: through Fri., 8 a.m. to 5 p.m. at 1-888-782-5678 or 717-988-0000 press 6 Via the Provider OnLine EDI tools, these batches can be viewed in several standard report formats. Medicaid and Medical Assistance Plans | UPMC for You 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. Your Username or Password? Pittsburgh, PA 15230-1600, Join our UPMC Dental Advantage Provider Network, ONC 21st Century Cures Act Member Resource Center. For Dental Providers | UPMC Health Plan // Array of month Names Dental Coverage | UPMC Community HealthChoices 2022 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences. Our Dental Advantage Newsletter includes the latest news and information for network providers. Our provider portal solutions make business transactions fast, simple and convenient, including: Submission of dental claims and prior authorizations . Resources for Dental Providers Vision Providers UPMC Dental Advantage offers competitive rates, convenient tools, and rapid reimbursement. For Providers | UPMC Community HealthChoices Have a sample 837 file exported from their billing system containing only UPMC Health Plan claims. PO Box 1600 DHMO providers will continue to receive paper checks and/or EFT payments as they do today, no action is required for DHMO payments. Find a Doctor or Provider. Forgot Complete testing and become certified with UPMC Health Plan. Login/Register. Login - UPMC For more information on dental services, view the UPMC Community HealthChoices Handbook . Please sign in to view patient eligibility, Select MyUPMC to access your UPMC health information. Get an immediate response if mistakes are made submitting a claim (using HIPAA 837 forms). Contact Us Current Members. dental care - Find a Doctor | UPMC Existing EFT payments set up with MetLife will remain unchanged, so no action is required on your part. Our dental health team at UPMC Cole offers high-quality family dental care at affordable pricing. Patients of UPMC Cole should select the UPMC Cole Connect Patient Portal. In the meantime, if you need to verify eligibility, plan information or submit a claim, please follow the instructions below. UPMC Health Plan OnLine - Health Plan Member Login Log In to the Dental Advantage Provider Portal Announcements Get the latest updates from UPMC Health Plan. Please use the following link to return to the UPMC Health Plan home pageUPMC Health Plan home page UPMC Dental Advantage Read Dental Announcements Provider Directory | Find Care | UPMC Health Plan Manage claimssubmit and manage claims entirely online. For patients of UPMC-affiliated doctors in Central Pa, select UPMC Central Pa Portal. Resources for UPMC Health Plan/SKYGEN Dental Providers. The UPMC Presbyterian Dental Center at UPMC Montefiore offers preventive and follow-up dental care. Submit claim forms to: The UPMC Presbyterian Dental Center at UPMC Montefiore offers preventive and follow-up dental care. As a provider-led health insurer, we have a unique appreciation for our relationships with network doctors and care providers. The Act creates specific negotiation and dispute resolution protocols between payer and provider. Search adult and pediatric providers and schedule appointments online. Find a Doctor, Specialist, or Provider | UPMC Provider Directory | Find Care | UPMC Health Plan The online provider search lets you find a person who provides . For Providers About Contact . First-time users can create a Provider OnLine account. var year = now.getFullYear() Determine a patient's primary insurance coverage. Need Help? We also treat serious dental issues to help you keep smiling. 2022 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences. . Electronically filed claims may be submitted in the following ways: Individual claim entry 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 Cole patients receiving inpatient care. 800-533-8762. So can you. Sign in to UPMC Cole Connect Patient Portal. Someone will contact you. 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^. PDF UPMC Dental Advantage Dental . Contact Our Dental Benefits Advisory Team, Join our UPMC Dental Advantage Provider Network, ONC 21st Century Cures Act Member Resource Center. document.write(dayNames[now.getDay()] + ", " + monthNames[now.getMonth()] + " " + now.getDate() + ", " + year); User name: Search adult and pediatric providers and schedule appointments online. How to Login? 412-647-8762 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. TTY: 711. We offer personalized dental care at UPMC Montefiore in Pittsburgh and UPMC Cole in Coudersport and Port Allegany, Pa. Western Pa. Not registered with UPMC Health Plan? var now = new Date(); the introduction of UPMC Dental Advantage. This portion of the UPMC Health Plan's website is strictly related to HIPAA-mandated EDI transactions. 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. UPMC Dental Advantage Provider Portal Visit our secure website, where network providers can sign in and complete most administrative tasks. Home & Community-Based Services . Providers are able to submit claims directly without incurring clearinghouse expenses. Login/Register. Your place to stay in control. Emdeon should use payer ID 23281. Home & Community-Based Services . Start Here. I am a: Login. With UPMC Health Plan's Provider OnLine, you can: A provider office should appoint a staff member to serve as Security Officer. Need to schedule by phone? The portal for UPMC patients in Central Pa. Dental and Vision Providers - UPMC Health Plan Health Plan Member Login For Health Care Providers | UPMC Health Plan As a network provider, you can: Verify eligibilitycheck plan status with a member's ID, full name, and date of birth. For a medical emergency, call 911 or go to the nearest emergency department. Were happy to give you more information about becoming a UPMC Dental Advantage provider. If you choose this option for claims submission and you do not have a Provider OnLine account, complete this form to sign up. Paper Claim Submission: For a medical emergency, call 911 or go to the nearest emergency dept. 200 Lothrop Street Find out how to apply for the Preferred Dentist Program These claims are loaded into batches and immediately posted in preparation for adjudication. Find out how Dental . PO Box 1600 Forgot Password? For a medical emergency, call 911 or go to the nearest emergency dept. var monthNames = new Array( For a medical emergency, call 911 or go to the nearest emergency department. 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 a medical emergency, call 911 or go to the nearest emergency department. The portal for all UPMC patients EXCEPT those in Central Pa. For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. Interact with the Health Plan on claims issues via a messaging system. Login::. - UPMC 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. Provider Directory | Find Care | UPMC Health Plan Resources for UPMC Health Plan/SKYGEN Dental Providers Providers submitting claims through Need to schedule by phone? View resources for medical providers, log into Provider OnLine, and get access to downloadable forms. Thank you for being a part of the UPMC Dental Advantage/UPMC Vision Advantage network. Welcome to MetDental.com. We apologize for this inconvenience and look forward to serving you the next time you sign in. UPMC Health Plan and SKYGEN Provider Manual. Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. Find listings of the care providers we partner with including doctors, hospitals, pharmacies . If you need help with your account, please call 1-866-884-8579. First-time users can create a Provider OnLine account. For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. This person will: If you have not accessed your Provider OnLine account in the past six months, your account may be disabled. 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). UPMC Health Plan's Provider OnLine. - Health Plan Member Login Get virtual care Schedule a video visit with your regular provider. UPMC Health Plan and SKYGEN Dental Provider Quick Reference Guide. Search adult and pediatric providers and schedule appointments online. Dentists in our network enjoy top-notch support that makes it easier to run a successful practice. Federal Employees: Federal Employees Health Benefits Program (FEHB) Dental Advantage Need to schedule by phone? Forgot username or password? Paper Claim Submission: Submit claim forms to: UPMC Dental Advantage PO Box 1600 Pittsburgh, PA 15230-1600 Providers may use the standard PGP encryption process in addition to the secure FTP, if additional data security is desired. Download a form for your practice, update your profile, or learn how to report fraud and abuse. If you are interested in HIPAA-compliant EDI file submission, please refer to the additional set-up documents on this website. *Administered by National Vision Administrators, Join our UPMC Dental Advantage Provider Network, ONC 21st Century Cures Act Member Resource Center. For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. Receive 24-hour access to claims and coverage information. Access formsfind provider manuals, plan sheets, lab program forms . It is important that you respond to VPoint to ensure your continued relationship with MetLife. Register. 1 Childrens Hospital Drive, 4401 Penn Avenue, Floor 7, Pittsburgh, PA 15224 (Map) Children's North Ambulatory Surgery Center. Advantage Dental Provider Portal First-time users can create an account by contacting their office Provider OnLine Account Administrator or by calling 1-800-937-0438. // Array of day names View members' historical coverage information. For technical questions about the UPMC Central PA Portal, contact the Help Desk Mon. You can follow up with additional questions to the HealthPlanEDI@upmc.edu distribution group. About the Electronic Remittance Advice UPMC CCP-South Fayette. How to Login? 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. Give us feedback on Provider OnLine. 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. Find care with UPMC Health Plan's Provider Directory. 2023 MetLife Services and Solutions, LLC, VPoint Credentialing and Recredentialing Services. Commercial and Medicare // patched for y2k bug! As a network dentist, youll get help with claims status, eligibility, and more. UPMC Community HealthChoices Dental Allowance Request Form. To learn more, visit healthwise.org. For Medical Providers | UPMC Health Plan

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