Submission of dental claims and prior authorizations, Member status and eligibility determination. Find out how to apply for Dental HMO/Managed Care Plan^. UPMC Health Plan and SKYGEN Provider Manual. Dental . 800-533-8762. Message your doctor Send a private, secure message to your provider, anytime. Through MetDental, participating Dentists can view rosters, search for Explanation of Payment statements, download Facility Reference Guides, and more. *Disclaimer: This online directory provides a list of UPMC Health Plan providers, and the information contained here is updated periodically. Individual claim entry, known as Prelog, is available to providers with established Health Plan online accounts. Visit our secure website, where network providers can sign in and complete most administrative tasks. Member Login. The online provider search lets you find a person who provides . UPMC Dental Advantage 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. Home & Community-Based Services . Commercial and Medicare Medicare Special Needs Plans: UPMC for Life Complete Care Dental Advantage. IN For a medical emergency, call 911 or go to the nearest emergency dept. To learn more, visit healthwise.org. Not registered with UPMC Health Plan? UPMC Health Plan and SKYGEN Product Guide. For a medical emergency, call 911 or go to the nearest emergency department. Our provider portal solutions make business transactions fast, simple and convenient, including: Submission of dental claims and prior authorizations . Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. If you can't log in, contact Sales Support at 1-855-862-6515. For Providers About Contact Search. UPMC Community HealthChoices (CHC) Dental Advantage 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. Vision . Patients of UPMC Cole should select the UPMC Cole Connect Patient Portal. We apologize for this inconvenience and look forward to serving you the next time you sign in. Phone: 1-800-286-4242. Access your UPMC information in MyUPMC. Serve as the provider practices primary contact with UPMC Health Plan regarding Provider OnLine security issues. Batch file submissions Learn more about our plans and programs, find a dentist, or sign in to view patient eligibility, plan detail, and claims. For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. Please be advised Zelis is the new payment solution for MetLife claim payments. Have the ability to download and install a free Active-X secure FTP add-on. Submit claim forms to: Login This application is best viewed using Internet Explorer versions 6.0 and higher Login As Provider Network Login Name Password Home Forgot Password? "January","February","March","April","May","June","July","August","September","October","November","December"); For a medical emergency, call 911 or go to the nearest emergency department. Password: Forgot Password? through Fri., 8 a.m. to 5 p.m. at 1-888-782-5678 or 717-988-0000 press 6 Login/Register. Dental . We offer personalized dental care at UPMC Montefiore in Pittsburgh and UPMC Cole in Coudersport and Port Allegany, Pa. Western Pa. Paper Claim Submission: Submit claim forms to: UPMC Dental Advantage PO Box 1600 Pittsburgh, PA 15230-1600 Medical Assistance: First-time users can create an account by contacting their office Provider OnLine Account Administrator or by calling 1-800-937-0438. The UPMC Presbyterian Dental Center at UPMC Montefiore offers preventive and follow-up dental care. Find care with UPMC Health Plan's Provider Directory. DHMO providers will have the ability to manage all payments under one experience on the Zelis platform in future phases. Medicare: UPMC for Life Dental Advantage (University of Pittsburgh retirees only) More Contact Options ; . Welcome to UPMC for You! To learn how to register, watch our instructional Provider OnLine registration video. Important: Please provide your National Provider Identifier (NPI) when prompted. Providers are able to submit claims directly without incurring clearinghouse expenses. 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. Forgot username or password? Browse doctors by specialty, procedure, service, or equipment to find the best fit for you! The plan is designed to encourage regular preventive care and foster open communication between patients and dentists regarding recommended treatment plans. The provider's office can enter claims and verify if they have been accepted and are ready for adjudication. Children's Health Insurance Program: UPMC for Kids (CHIP) Dental Advantage Contact Us Current Members. Contact Our Dental Benefits Advisory Team, Join our UPMC Dental Advantage Provider Network, ONC 21st Century Cures Act Member Resource Center. Need to schedule by phone? This portion of the UPMC Health Plan's website is strictly related to HIPAA-mandated EDI transactions. Make an appointment For a medical emergency, call 911 or go to the nearest emergency department. Get the latest updates from UPMC Health Plan. UPMC CCP-South Fayette. For member identification, submit the member's 11-digit ID number or the government-assigned identifiers for Medicare or Medical Assistance members. Providers. The portal for UPMC Cole patients receiving inpatient care. Medical . Find out how to apply for the Preferred Dentist Program Find a UPMC health care facility close to you quickly by browsing by region. Chat with a UPMC Health Plan provider service representative in real time. View resources for medical providers, log into Provider OnLine, and get access to downloadable forms. 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. 412-647-8762 In the meantime, if you need to verify eligibility, plan information or submit a claim, please follow the instructions below. Your Username or Password? Have a sample 837 file exported from their billing system containing only UPMC Health Plan claims. Vision . Grant access to Provider OnLine to certain staff members on the provider's behalf. If you need help with your account, please call 1-866-884-8579. Sign in ; Register . Get the latest news and information about the Dental HMO/Managed Care Network^ and Products. You also can register to join the network. You also can register to join the network. At this time, only PPO providers currently receiving their payments by checks will be included in this phase. TTY: 711. Please use the following link to return to the UPMC Health Plan home pageUPMC Health Plan home page DHMO providers will continue to receive paper checks and/or EFT payments as they do today, no action is required for DHMO payments. 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. Get an immediate response if mistakes are made submitting a claim (using HIPAA 837 forms). Paper Claim Submission: 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. First-time users can create a Provider OnLine account. UPMC Vision Advantage Search adult and pediatric providers and schedule appointments online. For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. We also treat serious dental issues to help you keep smiling. Were happy to give you more information about becoming a UPMC Dental Advantage provider. Register. Patients of UPMC Cole should select the UPMC Cole Connect Patient Portal. 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. Interact with the Health Plan on claims issues via a messaging system. // patched for y2k bug! The Act creates specific negotiation and dispute resolution protocols between payer and provider. For Providers About Contact . 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. . Announcements As a participating provider, you can access valuable information online by entering your user ID and password in the login box on this page. Video Visit. User Login. 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. Log In to the Dental Advantage Provider Portal Announcements Get the latest updates from UPMC Health Plan. I am a: Login. Please submit the National Provider Identifier (NPI), along with the tax ID and the provider ID as assigned by UPMC Health Plan. Dental Care at UPMC Our dental experts can help you to put your best face forward. For Providers About Contact . It requires the recipient's Practice or Billing System have the ability to automate loading of a file in the mandated format. Need to schedule by phone? 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! Our dental experts can help you to put your best face forward. Start Here. You can follow up with additional questions to the HealthPlanEDI@upmc.edu distribution group. In order to submit EDI files directly to the Health Plan, providers must: UPMC Health Plan currently accepts dual provider identifiers. 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. These clearinghouses are then responsible for reformatting these claims to meet HIPAA standards and passing the claims on to the 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^. Register. Make Provider OnLine security requests to UPMC Health Plan on behalf of other staff members. Here you can explore resources and information about Medical Assistance coverage and benefits. I am a: Login. UPMC Dental Advantage Provider Portal Visit our secure website, where network providers can sign in and complete most administrative tasks. Search adult and pediatric providers and schedule appointments online. Online Login: UserID I forgot my user id (Members Only) : There was an error with the Pass through from your Public Website. Get virtual care Schedule a video visit with your regular provider. For general assistance or inquiries regarding web portals or logins, please contact us here. Your dedicated network manager can answer questions and keep you current on new benefits, features, and products. // Array of month Names Forgot Find listings of the care providers we partner with including doctors, hospitals, pharmacies . UPMC Community HealthChoices Dental Allowance Request Form. 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. 2023 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences, Supplemental content provided by Healthwise, Incorporated. Access formsfind provider manuals, plan sheets, lab program forms . First-time users can create an account by contacting their office Provider OnLine Account Administrator or by calling 1-800-937-0438. Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. DenteMax is one of the largest leasable dental PPO networks in the United States. Need to schedule by phone? Our Dental Advantage Newsletter includes the latest news and information for network providers. Forgot username or password? Login/Register. Search adult and pediatric providers and schedule appointments online. Discover the advantages of joining, and learn about resources available to you as a network provider. var year = now.getFullYear() Need to schedule by phone? Existing EFT payments set up with MetLife will remain unchanged, so no action is required on your part. 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. UPMC Health Plan and SKYGEN Dental Provider Quick Reference Guide. 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. If you have questions while you are completing the form, contact our Web Support Services at 1-800-937-0438. Determine a patient's primary insurance coverage. Electronically filed claims may be submitted in the following ways: Individual claim entry With UPMC Health Plan's Provider OnLine, you can: A provider office should appoint a staff member to serve as Security Officer. Home & Community-Based Services . PO Box 1600 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. . View up-to-date eligibility, PCP information, and covered benefits. Please sign in to view patient eligibility, 200 Lothrop Street Pittsburgh, PA 15213 412-647-8762 800-533-8762 For patients of UPMC-affiliated doctors in Central Pa, select UPMC Central Pa Portal. *Administered by National Vision Administrators, Join our UPMC Dental Advantage Provider Network, ONC 21st Century Cures Act Member Resource Center. Advantage Dental Provider Portal We have moved! 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. MetLife is committed to helping our providers have a smooth transition to our new enrollment solution with as little disruption as possible. I am a: Login. Learn about and take advantage of the resources available to you as a network provider. 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. Get the latest resources, news, and announcements from UPMC Health Plan for participating providers. 2022 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences. 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. Forgot To verify eligibility and plan information, please call: Claims and pre-determinations should be submitted using one of the methods below: Clearinghouse Submission: Not registered with UPMC Health Plan? As a participating provider, you can access valuable information via Provider OnLine. If you forgot your User ID or need assistance, please call our Help Desk at 1-800-937-0438. Start Here. Register. 2022 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences. For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. var monthNames = new Array( These resources, such as the Provider Manual, can assist you with administrative and practice needs. 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). 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. 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. Thousands of CE credits awarded online. Pittsburgh, PA 15230-1600. Forgot username or password? For a medical emergency, call 911 or go to the nearest emergency dept. Browse doctors by specialty, procedure, service, or equipment to find the best fit for you! Emdeon should use payer ID 23281. Select MyUPMC to access your UPMC health information. document.write(dayNames[now.getDay()] + ", " + monthNames[now.getMonth()] + " " + now.getDate() + ", " + year); User name: 205 Millers Run Road, Suite 300, Bridgeville, PA 15017 (Map) 724-934-3334. For a medical emergency, call 911 or go to the nearest emergency dept. Pharmacy . Dentistry - Find a Doctor | UPMC Need Care? For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. Claims should be submitted using one of the methods below: Clearinghouse Submission: So many helpful features. This person will: If you have not accessed your Provider OnLine account in the past six months, your account may be disabled. Interested in joining UPMC Health Plans provider network? As a provider-led health insurer, we have a unique appreciation for our relationships with network doctors and care providers. Resources for UPMC Health Plan/SKYGEN Dental Providers. 2022 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences. If you forgot your user ID or need assistance, please call our Help Desk at 1-800-937-0438. 200 Lothrop Street If you are interested in HIPAA-compliant EDI file submission, please refer to the additional set-up documents on this website. The portal for UPMC patients in Central Pa. Via the Provider OnLine EDI tools, these batches can be viewed in several standard report formats. Find care with UPMC Health Plan's Provider Directory. Find a Doctor or Provider. View plansget vision and dental plan information prior to the member's visit. Visit UPMC Health Plan's homepage. Search adult and pediatric providers and schedule appointments online. If you choose this option for claims submission and you do not have a Provider OnLine account, complete this form to sign up.