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