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