Our Provider Partner Update newsletter includes the latest news and information for network providers. DHMO providers will continue to receive paper checks and/or EFT payments as they do today, no action is required for DHMO payments. UPMC Community HealthChoices (CHC) Dental Advantage var dayNames = new Array("Sunday","Monday","Tuesday","Wednesday","Thursday","Friday","Saturday"); Thousands of CE credits awarded online. Health Plan Member Login For more information on dental services, view the UPMC Community HealthChoices Handbook . So can you. Home & Community-Based Services . 800-533-8762. Find listings of the care providers we partner with including doctors, hospitals, pharmacies . Provider Directory | Find Care | UPMC Health Plan The UPMC Presbyterian Dental Center at UPMC Montefiore offers preventive and follow-up dental care. Submit claim forms to: Get an immediate response if mistakes are made submitting a claim (using HIPAA 837 forms). The UPMC Presbyterian Dental Center at UPMC Montefiore offers preventive and follow-up dental care. Get the latest resources, news, and announcements from UPMC Health Plan for participating providers. Pittsburgh, PA 15213 Resources for Medical Providers Dental Providers Learn about the dental products UPMC Health Plan offers and the variety of resources available to network providers. Phone: 1-800-286-4242. Medical . Download a form for your practice, update your profile, or learn how to report fraud and abuse. . Login This application is best viewed using Internet Explorer versions 6.0 and higher Login As Provider Network Login Name Password Home Forgot Password? IN For a medical emergency, call 911 or go to the nearest emergency department. Dental . Dentists in our network enjoy top-notch support that makes it easier to run a successful practice. If you choose this option for claims submission and you do not have a Provider OnLine account, complete this form to sign up. Not registered with UPMC Health Plan? 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. For member identification, submit the member's 11-digit ID number or the government-assigned identifiers for Medicare or Medical Assistance members. For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. How to Login? DHMO providers will have the ability to manage all payments under one experience on the Zelis platform in future phases. Not a UPMC Central PA Portal Patient? 1 Childrens Hospital Drive, 4401 Penn Avenue, Floor 7, Pittsburgh, PA 15224 (Map) Children's North Ambulatory Surgery Center. Please be advised MetLife has contracted VPoint to provide credentialing and recredentialing services on MetLife's behalf. Were happy to give you more information about becoming a UPMC Dental Advantage provider. Welcome to MetDental.com. For additional information, please call SKYGEN Provider Services at 1-855-806-5193 or email providerservices@skygenusa.com. 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. Our Dental Advantage Newsletter includes the latest news and information for network providers. If you have questions while you are completing the form, contact our Web Support Services at 1-800-937-0438. UPMC Health Plan's Provider OnLine. - Health Plan Member Login Have a sample 837 file exported from their billing system containing only UPMC Health Plan claims. MetDental.com 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). The Act creates specific negotiation and dispute resolution protocols between payer and provider. Visit our secure website, where network providers can sign in and complete most administrative tasks. Medical Assistance: To learn how to register, watch our instructional Provider OnLine registration video. Register. Pharmacy . Our dental health team at UPMC Cole offers high-quality family dental care at affordable pricing. Interact with the Health Plan on claims issues via a messaging system. The plan is designed to encourage regular preventive care and foster open communication between patients and dentists regarding recommended treatment plans. Interested in joining UPMC Health Plans provider network? For a medical emergency, call 911 or go to the nearest emergency dept. The portal for UPMC Cole patients receiving inpatient care. For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. For Providers About Contact . Providers may use the standard PGP encryption process in addition to the secure FTP, if additional data security is desired. It is important that you respond to VPoint to ensure your continued relationship with MetLife. Providers. 2023 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences, Supplemental content provided by Healthwise, Incorporated. Vision . Forgot username or password? Chat with a UPMC Health Plan provider service representative in real time. 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 immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. As a network dentist, youll get help with claims status, eligibility, and more. Vision . // Array of day names Submit claim forms to: Announcements Dental and Vision Providers - UPMC Health Plan *Disclaimer: This online directory provides a list of UPMC Health Plan providers, and the information contained here is updated periodically. Claims should be submitted using one of the methods below: Clearinghouse Submission: UPMC Health Plan and SKYGEN Dental Provider Quick Reference Guide. Medicare: UPMC for Life Dental Advantage (University of Pittsburgh retirees only) UPMC Dental Advantage Provider Portal Visit our secure website, where network providers can sign in and complete most administrative tasks. Paper Claim Submission: Submit claim forms to: UPMC Dental Advantage PO Box 1600 Pittsburgh, PA 15230-1600 Emdeon should use payer ID 25184. About the Electronic Remittance Advice Claim files are transmitted using a secure FTP process that does not require data encryption prior to transmission. For Dental Providers | UPMC Health Plan Emdeon should use payer ID 23281. Providers Home - Avesis Start Here. Get the latest news and information on the EFT/ERA Overview page in the resource center. Thank you for being a part of the UPMC Dental Advantage/UPMC Vision Advantage network. 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. Need to schedule by phone? We use the latest oral health technology and tools so you can feel good about flashing those pearly whites. 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. 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. Dominion National provides dental plans and administrative services to UPMC Health Plan members and maintains an extensive selection of participating dentists. Learn more about our plans and programs, find a dentist, or sign in to view patient eligibility, plan detail, and claims. the introduction of UPMC Dental Advantage. 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. For a medical emergency, call 911 or go to the nearest emergency department. First-time users can create a Provider OnLine account. Make Provider OnLine security requests to UPMC Health Plan on behalf of other staff members. View plansget vision and dental plan information prior to the member's visit. Login/Register. MetLife is committed to helping our providers have a smooth transition to our new enrollment solution with as little disruption as possible. The portal for UPMC patients in Central Pa. These resources, such as the Provider Manual, can assist you with administrative and practice needs. Give us feedback on Provider OnLine. For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. 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. MyUPMC: Connect to Your UPMC Care Online Login - UPMC 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! More Contact Options ; . 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. . You also can register to join the network. The portal for all UPMC patients EXCEPT those in Central Pa. Need to schedule by phone? 2022 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences. Online Login: UserID I forgot my user id (Members Only) : There was an error with the Pass through from your Public Website. Forgot username or password? UPMC CCP-South Fayette. UPMC for You Dental Advantage You may search for dentists by zip code, proximity, and type on the provider search tool above for any of the dental options. Medicare Special Needs Plans: UPMC for Life Complete Care Dental Advantage. Your session has ended, thank you for using UPMC Health Plan OnLine. 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. Login to Provider Online. UPMC Health Plan and SKYGEN Provider Manual. Provider OnLine | UPMC Health Plan Submission of dental claims and prior authorizations, Member status and eligibility determination. Account Login | MyUPMC Log In To Your Account Username Password Sign Up Forgot Username? We offer personalized dental care at UPMC Montefiore in Pittsburgh and UPMC Cole in Coudersport and Port Allegany, Pa. Forgot Password? MyUPMC: Connect to Your UPMC Care Online Search adult and pediatric providers and schedule appointments online. If you need help with your account, please call 1-866-884-8579. Our dental experts can help you to put your best face forward. Dentistry - Find a Doctor | UPMC Dental . PO Box 1600 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. The provider's office can enter claims and verify if they have been accepted and are ready for adjudication. At this time, only PPO providers currently receiving their payments by checks will be included in this phase. Register. Dentistry - Find a Doctor | UPMC Need Care? Providers submitting claims through Commercial and Medicare Select MyUPMC to access your UPMC health information. Paper Claim Submission: Please sign in to view patient eligibility, var now = new Date(); Forgot username or password? As a provider-led health insurer, we have a unique appreciation for our relationships with network doctors and care providers. Your place to stay in control. As a network provider, you can: Verify eligibilitycheck plan status with a member's ID, full name, and date of birth. Our Dental Benefits Advisory Team is ready to answer your call. It requires the recipient's Practice or Billing System have the ability to automate loading of a file in the mandated format. Message your doctor Send a private, secure message to your provider, anytime. Browse doctors by specialty, procedure, service, or equipment to find the best fit for you! To learn more, visit healthwise.org. Find a UPMC health care facility close to you quickly by browsing by region. Batch file submissions This person will: If you have not accessed your Provider OnLine account in the past six months, your account may be disabled. Find care with UPMC Health Plan's Provider Directory. // patched for y2k bug! For Providers About Contact . 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. Find a Doctor, Specialist, or Provider | UPMC Medicaid and Medical Assistance Plans | UPMC for You Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. With UPMC Health Plan's Provider OnLine, you can: A provider office should appoint a staff member to serve as Security Officer. To verify eligibility and plan information, please call: Claims and pre-determinations should be submitted using one of the methods below: Clearinghouse Submission: