2023 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences, Supplemental content provided by Healthwise, Incorporated. Register. To learn more, visit healthwise.org. Search adult and pediatric providers and schedule appointments online. Learn how to get one now. 200 Lothrop Street Provider Directory | Find Care | UPMC Health Plan I am a: Login. UPMC Dental Advantage Give us feedback on Provider OnLine. Dental and Vision Providers - UPMC Health Plan Login::. - UPMC Log In to the Dental Advantage Provider Portal Announcements Get the latest updates from UPMC Health Plan. UPMC Health Plan's Provider OnLine. - Health Plan Member Login Register. We apologize for this inconvenience and look forward to serving you the next time you sign in. UPMC for You Dental Advantage View members' historical coverage information. Learn about the dental products UPMC Health Plan offers and the variety of resources available to network providers. Medical Assistance: Our dental experts can help you to put your best face forward. Resources for UPMC Health Plan/SKYGEN Dental Providers. 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. We offer personalized dental care at UPMC Montefiore in Pittsburgh and UPMC Cole in Coudersport and Port Allegany, Pa. Western Pa. Your session has ended, thank you for using UPMC Health Plan OnLine. Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. Access your UPMC information in MyUPMC. Vision . Forgot username or password? Our Provider Partner Update newsletter includes the latest news and information for network providers. View UPMC's other Patient Portals. *Administered by National Vision Administrators, Join our UPMC Dental Advantage Provider Network, ONC 21st Century Cures Act Member Resource Center. MyUPMC: Connect to Your UPMC Care Online Online Login: UserID I forgot my user id (Members Only) : There was an error with the Pass through from your Public Website. Home & Community-Based Services . 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. UPMC Dental Advantage offers competitive rates, convenient tools, and rapid reimbursement. Find listings of the care providers we partner with including doctors, hospitals, pharmacies . 1 Childrens Hospital Drive, 4401 Penn Avenue, Floor 7, Pittsburgh, PA 15224 (Map) Children's North Ambulatory Surgery Center. // patched for y2k bug! For Providers About Contact . 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: These clearinghouses are then responsible for reformatting these claims to meet HIPAA standards and passing the claims on to the Health Plan. Select MyUPMC to access your UPMC health information. Find Dental Care Near You | UPMC You may search for dentists by zip code, proximity, and type on the provider search tool above for any of the dental options. "January","February","March","April","May","June","July","August","September","October","November","December"); In the meantime, if you need to verify eligibility, plan information or submit a claim, please follow the instructions below. Dental Care at UPMC Our dental experts can help you to put your best face forward. Please use the following link to return to the UPMC Health Plan home pageUPMC Health Plan home page UPMC Vision Advantage and UPMC Vision Care* make it easy for you to give your patients high-quality vision care and preventive services. For Health Care Providers | UPMC Health Plan Medicare: UPMC for Life Dental Advantage (University of Pittsburgh retirees only) 2022 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences. UPMC Health Plan accepts electronic claims in data file transmissions. through Fri., 8 a.m. to 5 p.m. at 1-888-782-5678 or 717-988-0000 press 6 Receive 24-hour access to claims and coverage information. Contact Us Current Members. Need to schedule by phone? Provider Directory | Find Care | UPMC Health Plan Pharmacy . View plansget vision and dental plan information prior to the member's visit. As a provider-led health insurer, we have a unique appreciation for our relationships with network doctors and care providers. Phone: 1-800-286-4242. Need to schedule by phone? It requires the recipient's Practice or Billing System have the ability to automate loading of a file in the mandated format. Forgot Dental Providers | SKYGEN Read Dental Announcements Providers Home - Avesis to earn CE credits without leaving the office. View up-to-date eligibility, PCP information, and covered benefits. 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. Sign in/Register I am a:MemberProviderEmployerProducer Sign In Please enter your username. Claim files are transmitted using a secure FTP process that does not require data encryption prior to transmission. Login - UPMC Learn about and take advantage of the resources available to you as a network provider. Access formsfind provider manuals, plan sheets, lab program forms . 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. In order to submit EDI files directly to the Health Plan, providers must: UPMC Health Plan currently accepts dual provider identifiers. Find care with UPMC Health Plan's Provider Directory. UPMC Health Plan and SKYGEN Clinical Criteria effective 12/18/2022. Announcements 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. 205 Millers Run Road, Suite 300, Bridgeville, PA 15017 (Map) 724-934-3334. UPMC Health Plan and SKYGEN Provider Manual. For a medical emergency, call 911 or go to the nearest emergency dept. If you forgot your User ID or need assistance, please call our Help Desk at 1-800-937-0438. These claims are loaded into batches and immediately posted in preparation for adjudication. First-time users can create a Provider OnLine account. 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. Not registered with UPMC Health Plan? View resources for medical providers, log into Provider OnLine, and get access to downloadable forms. Providers. Behavioral Health . 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. Emdeon should use payer ID 23281. 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. var dayNames = new Array("Sunday","Monday","Tuesday","Wednesday","Thursday","Friday","Saturday"); IN For additional information, please call SKYGEN Provider Services at 1-855-806-5193 or email providerservices@skygenusa.com. To learn how to register, watch our instructional Provider OnLine registration video. The UPMC Presbyterian Dental Center at UPMC Montefiore offers preventive and follow-up dental care. 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. Start Here. Search adult and pediatric providers and schedule appointments online. UPMC Vision Advantage Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. Serve as the provider practices primary contact with UPMC Health Plan regarding Provider OnLine security issues. . First-time users can create a Provider OnLine account. Find care with UPMC Health Plan's Provider Directory. When care is coordinated, submit the referring provider NPI if available, as well as the name and UPIN. for a doctor or specialist. 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. var now = new Date(); Have a sample 837 file exported from their billing system containing only UPMC Health Plan claims. This person will: If you have not accessed your Provider OnLine account in the past six months, your account may be disabled. 2022 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences. PDF UPMC Dental Advantage First-time users can create an account by contacting their office Provider OnLine Account Administrator or by calling 1-800-937-0438. 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. How to Login? The UPMC Presbyterian Dental Center at UPMC Montefiore offers preventive and follow-up dental care. 412-647-8762 Please sign in to view patient eligibility, 2023 MetLife Services and Solutions, LLC, VPoint Credentialing and Recredentialing Services. Our Dental Benefits Advisory Team is ready to answer your call. The portal for UPMC Cole patients receiving inpatient care. 200 Lothrop Street Pittsburgh, PA 15213 412-647-8762 800-533-8762 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^. 800-533-8762. UPMC CCP-South Fayette. *Disclaimer: This online directory provides a list of UPMC Health Plan providers, and the information contained here is updated periodically. Emdeon should use payer ID 25184. Get the latest resources, news, and announcements from UPMC Health Plan for participating providers. For a medical emergency, call 911 or go to the nearest emergency dept. You also can register to join the network. For Providers About Contact . If you need help with your account, please call 1-866-884-8579. Your dedicated network manager can answer questions and keep you current on new benefits, features, and products. Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. Providers submitting claims through 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. User Login. Login to Provider Online. Browse doctors by specialty, procedure, service, or equipment to find the best fit for you! UPMC Health Plan and SKYGEN Product Guide. Contact Our Dental Benefits Advisory Team, Join our UPMC Dental Advantage Provider Network, ONC 21st Century Cures Act Member Resource Center. Discover the advantages of joining, and learn about resources available to you as a network provider. Manage claimssubmit and manage claims entirely online. Forgot username or password? Find out how UPMC Central PA Portal - Login Page 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. Don't have one? DenteMax | DenteMax Dental PPO Network Provider OnLine | UPMC Health Plan Complete testing and become certified with UPMC Health Plan. 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. Chat with a UPMC Health Plan provider service representative in real time. UPMC Health Plan and SKYGEN Dental Provider Quick Reference Guide. Get virtual care Schedule a video visit with your regular provider. Forgot Find a Doctor or Provider. So many helpful features. TTY: 711. Our Dental Advantage Newsletter includes the latest news and information for network providers. UPMC Community HealthChoices (CHC) Dental Advantage plan detail, and claims. Dominion National provides dental plans and administrative services to UPMC Health Plan members and maintains an extensive selection of participating dentists. 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. Dental . Children's Health Insurance Program: UPMC for Kids (CHIP) Dental Advantage Make Provider OnLine security requests to UPMC Health Plan on behalf of other staff members. If you choose this option for claims submission and you do not have a Provider OnLine account, complete this form to sign up. Have the ability to download and install a free Active-X secure FTP add-on. MetDental.com PO Box 1600 For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. dental care - Find a Doctor | UPMC Please submit the National Provider Identifier (NPI), along with the tax ID and the provider ID as assigned by UPMC Health Plan. Medicaid and Medical Assistance Plans | UPMC for You Please be advised MetLife has contracted VPoint to provide credentialing and recredentialing services on MetLife's behalf. Vision . As a participating provider, you can access valuable information via Provider OnLine. Pittsburgh, PA 15230-1600, Join our UPMC Dental Advantage Provider Network, ONC 21st Century Cures Act Member Resource Center. Determine a patient's primary insurance coverage. To verify eligibility and plan information, please call: Claims and pre-determinations should be submitted using one of the methods below: Clearinghouse Submission: Dental . Sign in ; Register . UPMC Health Plan Members | Dominion National The plan is designed to encourage regular preventive care and foster open communication between patients and dentists regarding recommended treatment plans. You can follow up with additional questions to the HealthPlanEDI@upmc.edu distribution group. If you can't log in, contact Sales Support at 1-855-862-6515. Our dental health team at UPMC Cole offers high-quality family dental care at affordable pricing. For a medical emergency, call 911 or go to the nearest emergency department. Use billing software that allows the generation of a HIPAA-compliant 837 professional or institutional file. Someone will contact you. Grant access to Provider OnLine to certain staff members on the provider's behalf. For member identification, submit the member's 11-digit ID number or the government-assigned identifiers for Medicare or Medical Assistance members. For a medical emergency, call 911 or go to the nearest emergency department. UPMC Community HealthChoices Dental Allowance Request Form. So can you. Get an immediate response if mistakes are made submitting a claim (using HIPAA 837 forms). Our provider portal is currently unavailable. For patients of UPMC-affiliated doctors in Central Pa, select UPMC Central Pa Portal. Health Plan Member Login Get the latest news and information on the EFT/ERA Overview page in the resource center. This portion of the UPMC Health Plan's website is strictly related to HIPAA-mandated EDI transactions. Pittsburgh, PA 15213 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.