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