Login/Register. Receive 24-hour access to claims and coverage information. UPMC for You Dental Advantage Our provider portal is currently unavailable. If you have questions while you are completing the form, contact our Web Support Services at 1-800-937-0438. Browse doctors by specialty, procedure, service, or equipment to find the best fit for you! Our clients of insurance companies, third-party administrators and various groups lease the DenteMax PPO network for use in their dental benefit plans in order to service their more than 20 million members nationwide. For more information on dental services, view the UPMC Community HealthChoices Handbook . For Providers About Contact . For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. Register. Find care with UPMC Health Plan's Provider Directory. Login This application is best viewed using Internet Explorer versions 6.0 and higher Login As Provider Network Login Name Password Home Forgot Password? These clearinghouses are then responsible for reformatting these claims to meet HIPAA standards and passing the claims on to the Health Plan. For member identification, submit the member's 11-digit ID number or the government-assigned identifiers for Medicare or Medical Assistance members. Providers. Not registered with UPMC Health Plan? 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. Provider Directory | Find Care | 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. Forgot Determine a patient's primary insurance coverage. PO Box 1600 Vision . Dentists in our network enjoy top-notch support that makes it easier to run a successful practice. Your Username or Password? For a medical emergency, call 911 or go to the nearest emergency department. Children's Health Insurance Program: UPMC for Kids (CHIP) Dental Advantage I am a: Login. For Providers | UPMC Community HealthChoices First-time users can create an account by contacting their office Provider OnLine Account Administrator or by calling 1-800-937-0438. Sign in ; Register . 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. UPMC Vision Advantage 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. Account Login | MyUPMC Log In To Your Account Username Password Sign Up Forgot Username? Manage claimssubmit and manage claims entirely online. Paper Claim Submission: Submit claim forms to: UPMC Dental Advantage PO Box 1600 Pittsburgh, PA 15230-1600 How to Login? Providers Home - Avesis Search adult and pediatric providers and schedule appointments online. DHMO providers will continue to receive paper checks and/or EFT payments as they do today, no action is required for DHMO payments. For Dental Providers | UPMC Health Plan Patients of UPMC Cole should select the UPMC Cole Connect Patient Portal. This portion of the UPMC Health Plan's website is strictly related to HIPAA-mandated EDI transactions. *Disclaimer: This online directory provides a list of UPMC Health Plan providers, and the information contained here is updated periodically. These claims are loaded into batches and immediately posted in preparation for adjudication. Interested in joining UPMC Health Plans provider network? 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. Learn how to get one now. For general assistance or inquiries regarding web portals or logins, please contact us here. Learn about the dental products UPMC Health Plan offers and the variety of resources available to network providers. 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. If you are interested in HIPAA-compliant EDI file submission, please refer to the additional set-up documents on this website. 2023 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences, Supplemental content provided by Healthwise, Incorporated. You can request that your account be reactivated by contacting 1-800-937-0438. View resources for medical providers, log into Provider OnLine, and get access to downloadable forms. Search adult and pediatric providers and schedule appointments online. Providers may use the standard PGP encryption process in addition to the secure FTP, if additional data security is desired. var now = new Date(); *Administered by National Vision Administrators, Join our UPMC Dental Advantage Provider Network, ONC 21st Century Cures Act Member Resource Center. Forgot username or password? We offer personalized dental care at UPMC Montefiore in Pittsburgh and UPMC Cole in Coudersport and Port Allegany, Pa. Someone will contact you. SIGN Please sign in to view patient eligibility, Dentistry - Find a Doctor | UPMC Need Care? So can you. Dental Coverage | UPMC Community HealthChoices If you forgot your User ID or need assistance, please call our Help Desk at 1-800-937-0438. For Health Care Providers | UPMC Health Plan for a doctor or specialist. First-time users can create a Provider OnLine account. . Paper Claim Submission: Batch file submissions 412-647-8762 Learn more about our plans and programs, find a dentist, or sign in to view patient eligibility, plan detail, and claims. Get virtual care Schedule a video visit with your regular provider. Forgot PO Box 1600 Browse doctors by specialty, procedure, service, or equipment to find the best fit for you! For a medical emergency, call 911 or go to the nearest emergency dept. 2022 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences. Give us feedback on Provider OnLine. Provider Directory | Find Care | UPMC Health Plan document.write(dayNames[now.getDay()] + ", " + monthNames[now.getMonth()] + " " + now.getDate() + ", " + year); User name: Please be advised Zelis is the new payment solution for MetLife claim payments. plan detail, and claims. MyUPMC: Connect to Your UPMC Care Online View members' historical coverage information. Find a Doctor or Provider - Provider Directory | Find Care | UPMC As a network provider, you can: Verify eligibilitycheck plan status with a member's ID, full name, and date of birth. 200 Lothrop Street Pittsburgh, PA 15213 412-647-8762 800-533-8762 So many helpful features. 1 Childrens Hospital Drive, 4401 Penn Avenue, Floor 7, Pittsburgh, PA 15224 (Map) Children's North Ambulatory Surgery Center. Learn about and take advantage of the resources available to you as a network provider. The UPMC Presbyterian Dental Center at UPMC Montefiore offers preventive and follow-up dental care. 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. Resources for UPMC Health Plan/SKYGEN Dental Providers UPMC Health Plan accepts electronic claims in data file transmissions. To verify eligibility and plan information, please call: Claims and pre-determinations should be submitted using one of the methods below: Clearinghouse Submission: . Please be advised MetLife has contracted VPoint to provide credentialing and recredentialing services on MetLife's behalf. Provider OnLine Features With UPMC Health Plan's Provider OnLine, you can: Please use the following link to return to the UPMC Health Plan home pageUPMC Health Plan home page Select MyUPMC to access your UPMC health information. Interact with the Health Plan on claims issues via a messaging system. Login to Provider Online. Home & Community-Based Services . 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 department. Existing EFT payments set up with MetLife will remain unchanged, so no action is required on your part. Find listings of the care providers we partner with including doctors, hospitals, pharmacies . Online Login: UserID I forgot my user id (Members Only) : There was an error with the Pass through from your Public Website. Not registered with UPMC Health Plan? 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^. Visit UPMC Health Plan's homepage. To learn more, visit healthwise.org. 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 . Need to schedule by phone? Claim files are transmitted using a secure FTP process that does not require data encryption prior to transmission. Our Provider Partner Update newsletter includes the latest news and information for network providers. MyUPMC: Connect to Your UPMC Care Online var dayNames = new Array("Sunday","Monday","Tuesday","Wednesday","Thursday","Friday","Saturday"); 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. Pittsburgh, PA 15230-1600. Need Help? Forgot username or password? We use the latest oral health technology and tools so you can feel good about flashing those pearly whites. Dental Providers | SKYGEN Medicaid and Medical Assistance Plans | UPMC for You For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. UPMC Health Plan's Provider OnLine. - Health Plan Member Login The plan is designed to encourage regular preventive care and foster open communication between patients and dentists regarding recommended treatment plans. Our provider portal solutions make business transactions fast, simple and convenient, including: Submission of dental claims and prior authorizations . Medicare Special Needs Plans: UPMC for Life Complete Care Dental Advantage. UPMC CCP-South Fayette. For Providers About Contact Search. We apologize for this inconvenience and look forward to serving you the next time you sign in. Call your provider's office or 1-800-533-8762. To learn how to register, watch our instructional Provider OnLine registration video. Start Here. Grant access to Provider OnLine to certain staff members on the provider's behalf. Claims should be submitted using one of the methods below: Clearinghouse Submission: For a medical emergency, call 911 or go to the nearest emergency department. 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. Browse doctors by specialty, procedure, service, or equipment to find the best fit for you! Need to schedule by phone? Commercial and Medicare PDF UPMC Dental Advantage Welcome to MetDental.com. Contact Our Dental Benefits Advisory Team, Join our UPMC Dental Advantage Provider Network, ONC 21st Century Cures Act Member Resource Center. Here you can explore resources and information about Medical Assistance coverage and benefits. You can follow up with additional questions to the HealthPlanEDI@upmc.edu distribution group. 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. Dental . For Medical Providers | 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. // patched for y2k bug! UPMC Dental Advantage offers competitive rates, convenient tools, and rapid reimbursement. Your health information, right at your fingertips. Submit claim forms to: Login/Register. Sign in/Register I am a:MemberProviderEmployerProducer Sign In Please enter your username. For a medical emergency, call 911 or go to the nearest emergency dept. Resources for Dental Providers Vision Providers Forgot username or password? Login - UPMC Advantage Dental Provider Portal UPMC Health Plan and SKYGEN Product Guide. Have the ability to download and install a free Active-X secure FTP add-on. Register. Video Visit. Providers are able to submit claims directly without incurring clearinghouse expenses. UPMC Dental Advantage TTY: 711. For technical questions about the UPMC Central PA Portal, contact the Help Desk Mon. . Health Plan Member Login First-time users can create a Provider OnLine account. Our dental experts can help you to put your best face forward. The online provider search lets you find a person who provides . Start Here. Password: If you need assistance, please call our Help Desk at 1-800-937-0438. The portal for all UPMC patients EXCEPT those in Central Pa. Were happy to give you more information about becoming a UPMC Dental Advantage provider. dental care - Find a Doctor | UPMC Providers submitting claims through Your place to stay in control. To learn how to register, watch our instructional Provider OnLine registration video. Access formsfind provider manuals, plan sheets, lab program forms . Welcome to UPMC for You! Dental Care at UPMC Our dental experts can help you to put your best face forward. Medical Assistance: DHMO providers will have the ability to manage all payments under one experience on the Zelis platform in future phases. Sign in to 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. Visit our secure website, where network providers can sign in and complete most administrative tasks. Make Provider OnLine security requests to UPMC Health Plan on behalf of other staff members. Thank you for being a part of the UPMC Dental Advantage/UPMC Vision Advantage network. The UPMC Presbyterian Dental Center at UPMC Montefiore offers preventive and follow-up dental care. Electronically filed claims may be submitted in the following ways: Individual claim entry 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. You may search for dentists by zip code, proximity, and type on the provider search tool above for any of the dental options. . For patients of UPMC-affiliated doctors in Central Pa, select UPMC Central Pa Portal. Medical . // Array of day names Get the latest news and information on the EFT/ERA Overview page in the resource center. I am a: 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. Providers submitting claims through Serve as the provider practices primary contact with UPMC Health Plan regarding Provider OnLine security issues. Use billing software that allows the generation of a HIPAA-compliant 837 professional or institutional file. UPMC Dental Advantage Provider Portal Visit our secure website, where network providers can sign in and complete most administrative tasks. UPMC Health Plan OnLine - Health Plan Member Login DenteMax is one of the largest leasable dental PPO networks in the United States. to earn CE credits without leaving the office. Please submit the National Provider Identifier (NPI), along with the tax ID and the provider ID as assigned by UPMC Health Plan. 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. User Login. Medicare: UPMC for Life Dental Advantage (University of Pittsburgh retirees only) These resources, such as the Provider Manual, can assist you with administrative and practice needs. When care is coordinated, submit the referring provider NPI if available, as well as the name and UPIN. 205 Millers Run Road, Suite 300, Bridgeville, PA 15017 (Map) 724-934-3334. Contact Us Current Members. Get the latest news and information about the Dental HMO/Managed Care Network^ and Products. Your session has ended, thank you for using UPMC Health Plan OnLine. For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. Dominion National provides dental plans and administrative services to UPMC Health Plan members and maintains an extensive selection of participating dentists. Chat with a UPMC Health Plan provider service representative in real time. As a network dentist, youll get help with claims status, eligibility, and more. // Array of month Names 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. Login::. - UPMC Advantage Dental Provider Portal We have moved! If you can't log in, contact Sales Support at 1-855-862-6515. IN View plansget vision and dental plan information prior to the member's visit. Find care with UPMC Health Plan's Provider Directory. Federal Employees: Federal Employees Health Benefits Program (FEHB) Dental Advantage Submit claim forms to: 2022 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences. View resources for medical providers, log into Provider OnLine, and get access to downloadable forms. Important: Please provide your National Provider Identifier (NPI) when prompted. Our Dental Advantage Newsletter includes the latest news and information for network providers. Home & Community-Based Services . The portal for UPMC Cole patients receiving inpatient care. In the meantime, if you need to verify eligibility, plan information or submit a claim, please follow the instructions below. With UPMC Health Plan's Provider OnLine, you can: A provider office should appoint a staff member to serve as Security Officer. 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. It is important that you respond to VPoint to ensure your continued relationship with MetLife.