Your Username or Password? Announcements DenteMax is one of the largest leasable dental PPO networks in the United States. Dental Care at UPMC Our dental experts can help you to put your best face forward. If you choose this option for claims submission and you do not have a Provider OnLine account, complete this form to sign up. Providers. Commercial and Medicare
Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. 2023 MetLife Services and Solutions, LLC, VPoint Credentialing and Recredentialing Services. Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. Learn how to get one now. Phone: 1-800-286-4242. For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. 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. Learn about and take advantage of the resources available to you as a network provider. 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. Start Here. Your health information, right at your fingertips. Search adult and pediatric providers and schedule appointments online. UPMC Vision Advantage
Dentists in our network enjoy top-notch support that makes it easier to run a successful practice. Provider OnLine Features With UPMC Health Plan's Provider OnLine, you can: Register. Providers are able to submit claims directly without incurring clearinghouse expenses. View members' historical coverage information. Make an appointment For a medical emergency, call 911 or go to the nearest emergency dept. Make Provider OnLine security requests to UPMC Health Plan on behalf of other staff members. 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. As a network provider, you can: Verify eligibilitycheck plan status with a member's ID, full name, and date of birth. Submission of dental claims and prior authorizations, Member status and eligibility determination. Medicare: UPMC for Life Dental Advantage (University of Pittsburgh retirees only)
Find out how to apply for the Preferred Dentist Program Discover the advantages of joining, and learn about resources available to you as a network provider. I am a: Login. Access formsfind provider manuals, plan sheets, lab program forms . Our dental experts can help you to put your best face forward. UPMC Community HealthChoices Dental Allowance Request Form. 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. Need Help? Login/Register. // patched for y2k bug! document.write(dayNames[now.getDay()] + ", " + monthNames[now.getMonth()] + " " + now.getDate() + ", " + year); User name: Paper Claim Submission:
First-time users can create an account by contacting their office Provider OnLine Account Administrator or by calling 1-800-937-0438. For a medical emergency, call 911 or go to the nearest emergency department. Get the latest news and information about the Dental HMO/Managed Care Network^ and Products. Dominion National provides dental plans and administrative services to UPMC Health Plan members and maintains an extensive selection of participating dentists. To verify eligibility and plan information, please call: Claims and pre-determinations should be submitted using one of the methods below: Clearinghouse Submission:
You may search for dentists by zip code, proximity, and type on the provider search tool above for any of the dental options. Don't have one? Dentistry - Find a Doctor | UPMC Need Care? For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. View resources for medical providers, log into Provider OnLine, and get access to downloadable forms. Login to Provider Online. 200 Lothrop Street Pittsburgh, PA 15213 412-647-8762 800-533-8762 We offer personalized dental care at UPMC Montefiore in Pittsburgh and UPMC Cole in Coudersport and Port Allegany, Pa. Western Pa. Download a form for your practice, update your profile, or learn how to report fraud and abuse. . Dental . For Providers About Contact . Receive 24-hour access to claims and coverage information. Please be advised MetLife has contracted VPoint to provide credentialing and recredentialing services on MetLife's behalf. 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 member identification, submit the member's 11-digit ID number or the government-assigned identifiers for Medicare or Medical Assistance members. Existing EFT payments set up with MetLife will remain unchanged, so no action is required on your part. Providers submitting claims through
Password: Dental . You can request that your account be reactivated by contacting 1-800-937-0438. For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. Please submit the National Provider Identifier (NPI), along with the tax ID and the provider ID as assigned by UPMC Health Plan. DHMO providers will have the ability to manage all payments under one experience on the Zelis platform in future phases. Account Login | MyUPMC Log In To Your Account Username Password Sign Up Forgot Username? 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. These claims are loaded into batches and immediately posted in preparation for adjudication. Search adult and pediatric providers and schedule appointments online. First-time users can create a Provider OnLine account. Federal Employees: Federal Employees Health Benefits Program (FEHB) Dental Advantage
Select MyUPMC to access your UPMC health information. I am a: Login. You can follow up with additional questions to the HealthPlanEDI@upmc.edu distribution group. It is important that you respond to VPoint to ensure your continued relationship with MetLife. For a medical emergency, call 911 or go to the nearest emergency dept. Use billing software that allows the generation of a HIPAA-compliant 837 professional or institutional file. UPMC Health Plan and SKYGEN Clinical Criteria effective 12/18/2022. Find a UPMC health care facility close to you quickly by browsing by region. UPMC Dental Advantage
Medical Assistance:
Behavioral Health . Visit UPMC Health Plan's homepage. 2599 Wexford Bayne Road, Sewickley, PA 15143 (Map) 724-933-3700. Browse doctors by specialty, procedure, service, or equipment to find the best fit for you! Please be advised Zelis is the new payment solution for MetLife claim payments. Medical . 800-533-8762. Resources for UPMC Health Plan/SKYGEN Dental Providers. Need to schedule by phone? TTY: 711. UPMC Dental Advantage Provider Portal Visit our secure website, where network providers can sign in and complete most administrative tasks. We apologize for this inconvenience and look forward to serving you the next time you sign in. Need to schedule by phone? This person will: If you have not accessed your Provider OnLine account in the past six months, your account may be disabled. Chat with a UPMC Health Plan provider service representative in real time. Get the latest news and information on the EFT/ERA Overview page in the resource center. For Providers About Contact Search. Welcome to MetDental.com. Login This application is best viewed using Internet Explorer versions 6.0 and higher Login As Provider Network Login Name Password Home Forgot Password? Not a UPMC Central PA Portal Patient? Your dedicated network manager can answer questions and keep you current on new benefits, features, and products. Emdeon should use payer ID 23281. We also treat serious dental issues to help you keep smiling. Contact Our Dental Benefits Advisory Team, Join our UPMC Dental Advantage Provider Network, ONC 21st Century Cures Act Member Resource Center. Interact with the Health Plan on claims issues via a messaging system. Find out how to apply for Dental HMO/Managed Care Plan^. .
1 Childrens Hospital Drive, 4401 Penn Avenue, Floor 7, Pittsburgh, PA 15224 (Map) Children's North Ambulatory Surgery Center. I am a: Login. Need to schedule by phone? 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. Access your UPMC information in MyUPMC. More Contact Options ; . Important: Please provide your National Provider Identifier (NPI) when prompted. Forgot View up-to-date eligibility, PCP information, and covered benefits. Read Dental Announcements For Providers About Contact . Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. var year = now.getFullYear() Individual claim entry, known as Prelog, is available to providers with established Health Plan online accounts. 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. At this time, only PPO providers currently receiving their payments by checks will be included in this phase. Vision . *Disclaimer: This online directory provides a list of UPMC Health Plan providers, and the information contained here is updated periodically. Our dental health team at UPMC Cole offers high-quality family dental care at affordable pricing. To learn more, visit healthwise.org. Forgot username or password? through Fri., 8 a.m. to 5 p.m. at 1-888-782-5678 or 717-988-0000 press 6 Patients of UPMC Cole should select the UPMC Cole Connect Patient Portal. Manage claimssubmit and manage claims entirely online. Find care with UPMC Health Plan's Provider Directory. 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^. For a medical emergency, call 911 or go to the nearest emergency department. For a medical emergency, call 911 or go to the nearest emergency department. 2022 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences. Our Dental Advantage Newsletter includes the latest news and information for network 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. Have a sample 837 file exported from their billing system containing only UPMC Health Plan claims. . Providers may use the standard PGP encryption process in addition to the secure FTP, if additional data security is desired. UPMC for You Dental Advantage
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. Get the latest resources, news, and announcements from UPMC Health Plan for participating providers. 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. For a medical emergency, call 911 or go to the nearest emergency department. Search adult and pediatric providers and schedule appointments online. These resources, such as the Provider Manual, can assist you with administrative and practice needs. The provider's office can enter claims and verify if they have been accepted and are ready for adjudication. Claim files are transmitted using a secure FTP process that does not require data encryption prior to transmission. PO Box 1600
So can you. Emdeon should use payer ID 25184. 412-647-8762 To learn how to register, watch our instructional Provider OnLine registration video. Paper Claim Submission: Submit claim forms to: UPMC Dental Advantage PO Box 1600 Pittsburgh, PA 15230-1600 Find a Doctor or Provider. Batch file submissions
Learn more about our plans and programs, find a dentist, or sign in to view patient eligibility, plan detail, and claims. It requires the recipient's Practice or Billing System have the ability to automate loading of a file in the mandated format. The portal for UPMC Cole patients receiving inpatient care. 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. Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. View UPMC's other Patient Portals. var dayNames = new Array("Sunday","Monday","Tuesday","Wednesday","Thursday","Friday","Saturday"); Not registered with UPMC Health Plan? You also can register to join the network. Video Visit. Register. Pittsburgh, PA 15230-1600. Vision . Home & Community-Based Services . Get an immediate response if mistakes are made submitting a claim (using HIPAA 837 forms). Forgot Children's Health Insurance Program: UPMC for Kids (CHIP) Dental Advantage
If you forgot your user ID or need assistance, please call our Help Desk at 1-800-937-0438. Dental . 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. For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. "January","February","March","April","May","June","July","August","September","October","November","December"); Member Login. 2023 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences, Supplemental content provided by Healthwise, Incorporated. Interested in joining UPMC Health Plans provider network? DHMO providers will continue to receive paper checks and/or EFT payments as they do today, no action is required for DHMO payments. If you forgot your User ID or need assistance, please call our Help Desk at 1-800-937-0438. First-time users can create a Provider OnLine account. Someone will contact you. We use the latest oral health technology and tools so you can feel good about flashing those pearly whites. 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. Complete testing and become certified with UPMC Health Plan. Login/Register. Find care with UPMC Health Plan's Provider Directory. 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). 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. Resources for Dental Providers Vision Providers This portion of the UPMC Health Plan's website is strictly related to HIPAA-mandated EDI transactions. For additional information, please call SKYGEN Provider Services at 1-855-806-5193 or email providerservices@skygenusa.com. If you have questions while you are completing the form, contact our Web Support Services at 1-800-937-0438. Our provider portal solutions make business transactions fast, simple and convenient, including: Submission of dental claims and prior authorizations . As a participating provider, you can access valuable information online by entering your user ID and password in the login box on this page. Submit claim forms to:
Register. UPMC Health Plan and SKYGEN Product Guide. Our Dental Benefits Advisory Team is ready to answer your call. Welcome to UPMC for You! Find listings of the care providers we partner with including doctors, hospitals, pharmacies . In the meantime, if you need to verify eligibility, plan information or submit a claim, please follow the instructions below. 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. Forgot username or password? // Array of day names Forgot Password? For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. First-time users can create an account by contacting their office Provider OnLine Account Administrator or by calling 1-800-937-0438. Learn about the dental products UPMC Health Plan offers and the variety of resources available to network providers. for a doctor or specialist.