Start Here. Individual claim entry, known as Prelog, is available to providers with established Health Plan online accounts. Our Dental Advantage Newsletter includes the latest news and information for network providers. 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. 2599 Wexford Bayne Road, Sewickley, PA 15143 (Map) 724-933-3700. . Get the latest news and information about the Dental HMO/Managed Care Network^ and Products. UPMC Dental Advantage Provider Portal Visit our secure website, where network providers can sign in and complete most administrative tasks. In the meantime, if you need to verify eligibility, plan information or submit a claim, please follow the instructions below. The portal for UPMC Cole patients receiving inpatient care. Video Visit. PO Box 1600 To verify eligibility and plan information, please call: Claims and pre-determinations should be submitted using one of the methods below: Clearinghouse Submission: for a doctor or specialist. the introduction of UPMC Dental Advantage. Login/Register. Pharmacy . Discover the advantages of joining, and learn about resources available to you as a network provider. The portal for UPMC patients in Central Pa. Your Username or Password? We offer personalized dental care at UPMC Montefiore in Pittsburgh and UPMC Cole in Coudersport and Port Allegany, Pa. Western Pa. Complete testing and become certified with UPMC Health Plan. 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. 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. 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. Contact Our Dental Benefits Advisory Team, Join our UPMC Dental Advantage Provider Network, ONC 21st Century Cures Act Member Resource Center. Grant access to Provider OnLine to certain staff members on the provider's behalf. View UPMC's other Patient Portals. Forgot Password? Login to Provider Online. Submit claim forms to: 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. 2022 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences. For a medical emergency, call 911 or go to the nearest emergency department. Search adult and pediatric providers and schedule appointments online. UPMC Community HealthChoices (CHC) Dental Advantage Batch file submissions Dentists in our network enjoy top-notch support that makes it easier to run a successful practice. Were happy to give you more information about becoming a UPMC Dental Advantage provider. For a medical emergency, call 911 or go to the nearest emergency department. Thousands of CE credits awarded online. UPMC Dental Advantage offers competitive rates, convenient tools, and rapid reimbursement. Find out how to apply for the Preferred Dentist Program Forgot username or password? We apologize for this inconvenience and look forward to serving you the next time you sign in. Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. I am a: Login. Medicare Special Needs Plans: UPMC for Life Complete Care Dental Advantage. Paper Claim Submission: Your dedicated network manager can answer questions and keep you current on new benefits, features, and products. Learn how to get one now. Vision . For technical questions about the UPMC Central PA Portal, contact the Help Desk Mon. Your health information, right at your fingertips. As a participating provider, you can access valuable information online by entering your user ID and password in the login box on this page. var monthNames = new Array( Find care with UPMC Health Plan's Provider Directory. Member Login. 2023 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences, Supplemental content provided by Healthwise, Incorporated. In order to submit EDI files directly to the Health Plan, providers must: UPMC Health Plan currently accepts dual provider identifiers. Access formsfind provider manuals, plan sheets, lab program forms . Interact with the Health Plan on claims issues via a messaging system. 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). Your place to stay in control. Get virtual care Schedule a video visit with your regular provider. For a medical emergency, call 911 or go to the nearest emergency department. Welcome to UPMC for You! Serve as the provider practices primary contact with UPMC Health Plan regarding Provider OnLine security issues. To learn how to register, watch our instructional Provider OnLine registration video. UPMC Health Plan accepts electronic claims in data file transmissions. Register. *Administered by National Vision Administrators, Join our UPMC Dental Advantage Provider Network, ONC 21st Century Cures Act Member Resource Center. Paper Claim Submission: If you are interested in HIPAA-compliant EDI file submission, please refer to the additional set-up documents on this website. For Providers About Contact . Browse doctors by specialty, procedure, service, or equipment to find the best fit for you! SIGN Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. If you forgot your user ID or need assistance, please call our Help Desk at 1-800-937-0438. Make Provider OnLine security requests to UPMC Health Plan on behalf of other staff members. . Paper Claim Submission: Submit claim forms to: UPMC Dental Advantage PO Box 1600 Pittsburgh, PA 15230-1600 var dayNames = new Array("Sunday","Monday","Tuesday","Wednesday","Thursday","Friday","Saturday"); 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. Resources for Medical Providers Dental Providers Learn about the dental products UPMC Health Plan offers and the variety of resources available to network providers. Commercial and Medicare Don't have one? It requires the recipient's Practice or Billing System have the ability to automate loading of a file in the mandated format. For Providers About Contact Search. Through MetDental, participating Dentists can view rosters, search for Explanation of Payment statements, download Facility Reference Guides, and more. These clearinghouses are then responsible for reformatting these claims to meet HIPAA standards and passing the claims on to the Health Plan. It is important that you respond to VPoint to ensure your continued relationship with MetLife. Sign in ; Register . You also can register to join the network. For member identification, submit the member's 11-digit ID number or the government-assigned identifiers for Medicare or Medical Assistance members. Have the ability to download and install a free Active-X secure FTP add-on. Sign in to UPMC Cole Connect Patient Portal. 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 View resources for medical providers, log into Provider OnLine, and get access to downloadable forms. Call your provider's office or 1-800-533-8762. UPMC for You Dental Advantage Use billing software that allows the generation of a HIPAA-compliant 837 professional or institutional file. This portion of the UPMC Health Plan's website is strictly related to HIPAA-mandated EDI transactions. Need to schedule by phone? Pittsburgh, PA 15230-1600, Join our UPMC Dental Advantage Provider Network, ONC 21st Century Cures Act Member Resource Center. As a participating provider, you can access valuable information via Provider OnLine. MetLife is committed to helping our providers have a smooth transition to our new enrollment solution with as little disruption as possible. DHMO providers will continue to receive paper checks and/or EFT payments as they do today, no action is required for DHMO payments. Our Dental Benefits Advisory Team is ready to answer your call. I am a: Login. 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. Message your doctor Send a private, secure message to your provider, anytime. Determine a patient's primary insurance coverage. TTY: 711. 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. Medicare: UPMC for Life Dental Advantage (University of Pittsburgh retirees only) If you need assistance, please call our Help Desk at 1-800-937-0438. Dentistry - Find a Doctor | UPMC Need Care? var year = now.getFullYear() UPMC Health Plan and SKYGEN Dental Provider Quick Reference Guide. Need to schedule by phone? 800-533-8762. For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. Login/Register. Your session has ended, thank you for using UPMC Health Plan OnLine. If you have questions while you are completing the form, contact our Web Support Services at 1-800-937-0438. The provider's office can enter claims and verify if they have been accepted and are ready for adjudication. Search adult and pediatric providers and schedule appointments online. To learn how to register, watch our instructional Provider OnLine registration video. Resources for UPMC Health Plan/SKYGEN Dental Providers. Find out how to apply for Dental HMO/Managed Care Plan^. For Providers About Contact . View plansget vision and dental plan information prior to the member's visit. Pittsburgh, PA 15213 If you can't log in, contact Sales Support at 1-855-862-6515. For a medical emergency, call 911 or go to the nearest emergency dept. 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. For a medical emergency, call 911 or go to the nearest emergency department. Password: For more information on dental services, view the UPMC Community HealthChoices Handbook . First-time users can create an account by contacting their office Provider OnLine Account Administrator or by calling 1-800-937-0438. 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. Get the latest resources, news, and announcements from UPMC Health Plan for participating providers. Claim files are transmitted using a secure FTP process that does not require data encryption prior to transmission. Someone will contact you. Important: Please provide your National Provider Identifier (NPI) when prompted. 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 now = new Date(); 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. 2023 MetLife Services and Solutions, LLC, VPoint Credentialing and Recredentialing Services. Dominion National provides dental plans and administrative services to UPMC Health Plan members and maintains an extensive selection of participating dentists. We offer personalized dental care at UPMC Montefiore in Pittsburgh and UPMC Cole in Coudersport and Port Allegany, Pa. Register. You can request that your account be reactivated by contacting 1-800-937-0438. Resources for Dental Providers Vision Providers 412-647-8762 Not a UPMC Central PA Portal Patient? Please be advised MetLife has contracted VPoint to provide credentialing and recredentialing services on MetLife's behalf. 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. Forgot username or password? 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. Login This application is best viewed using Internet Explorer versions 6.0 and higher Login As Provider Network Login Name Password Home Forgot Password? Chat with a UPMC Health Plan provider service representative in real time. Not registered with UPMC Health Plan? 2022 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences. Need to schedule by phone? Log In to the Dental Advantage Provider Portal Announcements Get the latest updates from UPMC Health Plan. To learn more, visit healthwise.org. Need to schedule by phone? Medical . Dental Care at UPMC Our dental experts can help you to put your best face forward. 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 document.write(dayNames[now.getDay()] + ", " + monthNames[now.getMonth()] + " " + now.getDate() + ", " + year); User name: Login/Register. Dental . We also treat serious dental issues to help you keep smiling. The UPMC Presbyterian Dental Center at UPMC Montefiore offers preventive and follow-up dental care. UPMC Health Plan and SKYGEN Product Guide. Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. Find care with UPMC Health Plan's Provider Directory. Our Provider Partner Update newsletter includes the latest news and information for network providers. "January","February","March","April","May","June","July","August","September","October","November","December"); Get the latest updates from UPMC Health Plan. Contact Us Current Members. Browse doctors by specialty, procedure, service, or equipment to find the best fit for you! Register. The online provider search lets you find a person who provides . Get the latest news and information on the EFT/ERA Overview page in the resource center. As a network dentist, youll get help with claims status, eligibility, and more. We use the latest oral health technology and tools so you can feel good about flashing those pearly whites. As a provider-led health insurer, we have a unique appreciation for our relationships with network doctors and care providers. This person will: If you have not accessed your Provider OnLine account in the past six months, your account may be disabled.