Contact Us Current Members. Our Dental Advantage Newsletter includes the latest news and information for network providers. // Array of month Names The plan is designed to encourage regular preventive care and foster open communication between patients and dentists regarding recommended treatment plans. Were happy to give you more information about becoming a UPMC Dental Advantage provider. TTY: 711. Resources for Dental Providers Vision Providers 2023 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences, Supplemental content provided by Healthwise, Incorporated. As a participating provider, you can access valuable information online by entering your user ID and password in the login box on this page. As a network dentist, youll get help with claims status, eligibility, and more. Our dental experts can help you to put your best face forward. Make Provider OnLine security requests to UPMC Health Plan on behalf of other staff members. Dental . Need Help? Patients of UPMC Cole should select the UPMC Cole Connect Patient Portal. Please be advised MetLife has contracted VPoint to provide credentialing and recredentialing services on MetLife's behalf. 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^. 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. Not a UPMC Central PA Portal Patient? If you need assistance, please call our Help Desk at 1-800-937-0438. Forgot username or password? 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. Manage claimssubmit and manage claims entirely online. It requires the recipient's Practice or Billing System have the ability to automate loading of a file in the mandated format. We offer personalized dental care at UPMC Montefiore in Pittsburgh and UPMC Cole in Coudersport and Port Allegany, Pa. Western Pa. 800-533-8762. As a participating provider, you can access valuable information online by entering your user ID and password in the login box on this page. SIGN 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. 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. plan detail, and claims. Need to schedule by phone? Individual claim entry, known as Prelog, is available to providers with established Health Plan online accounts. If you have questions while you are completing the form, contact our Web Support Services at 1-800-937-0438. For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. Batch file submissions Account Login | MyUPMC Log In To Your Account Username Password Sign Up Forgot Username? Register. The online provider search lets you find a person who provides . 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). The portal for UPMC Cole patients receiving inpatient care. For a medical emergency, call 911 or go to the nearest emergency dept. Access your UPMC information in MyUPMC. 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. Dental Care at UPMC Our dental experts can help you to put your best face forward. The provider's office can enter claims and verify if they have been accepted and are ready for adjudication. Forgot username or password? Use billing software that allows the generation of a HIPAA-compliant 837 professional or institutional file. The portal for UPMC patients in Central Pa. View up-to-date eligibility, PCP information, and covered benefits. 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. View plansget vision and dental plan information prior to the member's visit. Providers are able to submit claims directly without incurring clearinghouse expenses. Important: Please provide your National Provider Identifier (NPI) when prompted. 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. 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. 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. Dentistry - Find a Doctor | UPMC Need Care? Dominion National provides dental plans and administrative services to UPMC Health Plan members and maintains an extensive selection of participating dentists. Get the latest news and information on the EFT/ERA Overview page in the resource center. UPMC Health Plan and SKYGEN Product Guide. Login This application is best viewed using Internet Explorer versions 6.0 and higher Login As Provider Network Login Name Password Home Forgot Password? through Fri., 8 a.m. to 5 p.m. at 1-888-782-5678 or 717-988-0000 press 6 Login/Register. View members' historical coverage information. Advantage Dental Provider Portal We have moved! Through MetDental, participating Dentists can view rosters, search for Explanation of Payment statements, download Facility Reference Guides, and more. 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. PO Box 1600 UPMC CCP-South Fayette. For Providers About Contact Search. Visit our secure website, where network providers can sign in and complete most administrative tasks. I am a: Login. 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! To verify eligibility and plan information, please call: Claims and pre-determinations should be submitted using one of the methods below: Clearinghouse Submission: For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. var now = new Date(); About the Electronic Remittance Advice If you can't log in, contact Sales Support at 1-855-862-6515. This portion of the UPMC Health Plan's website is strictly related to HIPAA-mandated EDI transactions. Electronically filed claims may be submitted in the following ways: Individual claim entry In order to submit EDI files directly to the Health Plan, providers must: UPMC Health Plan currently accepts dual provider identifiers. Provider OnLine Features With UPMC Health Plan's Provider OnLine, you can: 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. To learn how to register, watch our instructional Provider OnLine registration video. First-time users can create an account by contacting their office Provider OnLine Account Administrator or by calling 1-800-937-0438. UPMC Vision Advantage Message your doctor Send a private, secure message to your provider, anytime. Our dental health team at UPMC Cole offers high-quality family dental care at affordable pricing. Patients of UPMC Cole should select the UPMC Cole Connect Patient Portal. Medical Assistance: Visit UPMC Health Plan's homepage. 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. The Act creates specific negotiation and dispute resolution protocols between payer and provider. 1 Childrens Hospital Drive, 4401 Penn Avenue, Floor 7, Pittsburgh, PA 15224 (Map) Children's North Ambulatory Surgery Center. Phone: 1-800-286-4242. // patched for y2k bug! For a medical emergency, call 911 or go to the nearest emergency department. Please use the following link to return to the UPMC Health Plan home pageUPMC Health Plan home page Our Dental Benefits Advisory Team is ready to answer your call. Find a UPMC health care facility close to you quickly by browsing by region. PO Box 1600 Select MyUPMC to access your UPMC health information. Find out how to apply for the Preferred Dentist Program Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. 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. More Contact Options ; . Existing EFT payments set up with MetLife will remain unchanged, so no action is required on your part. For more information on dental services, view the UPMC Community HealthChoices Handbook . Chat with a UPMC Health Plan provider service representative in real time. UPMC Health Plan accepts electronic claims in data file transmissions. Contact Our Dental Benefits Advisory Team, 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. Announcements 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. For Providers About Contact . Learn more about our plans and programs, find a dentist, or sign in to view patient eligibility, plan detail, and claims. Search adult and pediatric providers and schedule appointments online. Someone will contact you. These claims are loaded into batches and immediately posted in preparation for adjudication. Paper Claim Submission: // Array of day names DenteMax is one of the largest leasable dental PPO networks in the United States. At this time, only PPO providers currently receiving their payments by checks will be included in this phase. Complete testing and become certified with UPMC Health Plan. UPMC Dental Advantage Learn how to get one now. Our Provider Partner Update newsletter includes the latest news and information for network providers. Submit claim forms to: Log In to the Dental Advantage Provider Portal Announcements Get the latest updates from UPMC Health Plan. Dentists in our network enjoy top-notch support that makes it easier to run a successful practice. Get the latest resources, news, and announcements from UPMC Health Plan for participating providers. 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. UPMC Health Plan and SKYGEN Clinical Criteria effective 12/18/2022. I am a: Login. Please be advised Zelis is the new payment solution for MetLife claim payments. UPMC Dental Advantage Provider Portal Visit our secure website, where network providers can sign in and complete most administrative tasks. For general assistance or inquiries regarding web portals or logins, please contact us here. You also can register to join the network. Password: Give us feedback on Provider OnLine. Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. Browse doctors by specialty, procedure, service, or equipment to find the best fit for you! Forgot Password? For additional information, please call SKYGEN Provider Services at 1-855-806-5193 or email providerservices@skygenusa.com. Your dedicated network manager can answer questions and keep you current on new benefits, features, and products. UPMC for You Dental Advantage User Login. Get the latest news and information about the Dental HMO/Managed Care Network^ and Products. UPMC Health Plan and SKYGEN Provider Manual. Providers submitting claims through For member identification, submit the member's 11-digit ID number or the government-assigned identifiers for Medicare or Medical Assistance members. Need to schedule by phone? View resources for medical providers, log into Provider OnLine, and get access to downloadable forms. For a medical emergency, call 911 or go to the nearest emergency department. 2599 Wexford Bayne Road, Sewickley, PA 15143 (Map) 724-933-3700. Paper Claim Submission: Submit claim forms to: UPMC Dental Advantage PO Box 1600 Pittsburgh, PA 15230-1600 Our provider portal is currently unavailable. *Administered by National Vision Administrators, Join our UPMC Dental Advantage Provider Network, ONC 21st Century Cures Act Member Resource Center. Resources for UPMC Health Plan/SKYGEN Dental Providers. Sign in ; Register . 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. Register. 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. Make an appointment to earn CE credits without leaving the office. These resources, such as the Provider Manual, can assist you with administrative and practice needs. Member Login. As a network provider, you can: Verify eligibilitycheck plan status with a member's ID, full name, and date of birth. Find care with UPMC Health Plan's Provider Directory. For Providers About Contact . the introduction of UPMC Dental Advantage. The UPMC Presbyterian Dental Center at UPMC Montefiore offers preventive and follow-up dental care. Login to Provider Online. Need to schedule by phone? Grant access to Provider OnLine to certain staff members on the provider's behalf. Submission of dental claims and prior authorizations, Member status and eligibility determination. Find out how Submit claim forms to: 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. 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. 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 department. 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. Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. Medical . 200 Lothrop Street If you choose this option for claims submission and you do not have a Provider OnLine account, complete this form to sign up. So can you. For a medical emergency, call 911 or go to the nearest emergency dept. These clearinghouses are then responsible for reformatting these claims to meet HIPAA standards and passing the claims on to the Health Plan. . Dental . Don't have one? IN Sign in to UPMC Cole Connect Patient Portal. Welcome to UPMC for You! Vision .