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