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. 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. If you forgot your User ID or need assistance, please call our Help Desk at 1-800-937-0438. 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 via Provider OnLine. You can follow up with additional questions to the HealthPlanEDI@upmc.edu distribution group. 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! Forgot Password? If you have questions while you are completing the form, contact our Web Support Services at 1-800-937-0438. . In order to submit EDI files directly to the Health Plan, providers must: UPMC Health Plan currently accepts dual provider identifiers. If you need assistance, please call our Help Desk at 1-800-937-0438. Medicare Special Needs Plans: UPMC for Life Complete Care Dental Advantage. Start Here. Provider OnLine Features With UPMC Health Plan's Provider OnLine, you can: Search adult and pediatric providers and schedule appointments online. You also can register to join the network. Providers. Login/Register. 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? Resources for Medical Providers Dental Providers Learn about the dental products UPMC Health Plan offers and the variety of resources available to network providers. UPMC for You Dental Advantage Thousands of CE credits awarded online. The online provider search lets you find a person who provides . Paper Claim Submission: For a medical emergency, call 911 or go to the nearest emergency dept. Dominion National provides dental plans and administrative services to UPMC Health Plan members and maintains an extensive selection of participating dentists. Please be advised Zelis is the new payment solution for MetLife claim payments. Register. To verify eligibility and plan information, please call: Claims and pre-determinations should be submitted using one of the methods below: Clearinghouse Submission: Dental . 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. UPMC Dental Advantage var year = now.getFullYear() Our Dental Advantage Newsletter includes the latest news and information for network providers. Learn about and take advantage of the resources available to you as a network provider. Our provider portal solutions make business transactions fast, simple and convenient, including: Submission of dental claims and prior authorizations . Login This application is best viewed using Internet Explorer versions 6.0 and higher Login As Provider Network Login Name Password Home Forgot Password? Find out how to apply for Dental HMO/Managed Care Plan^. Call your provider's office or 1-800-533-8762. Individual claim entry, known as Prelog, is available to providers with established Health Plan online accounts. The UPMC Presbyterian Dental Center at UPMC Montefiore offers preventive and follow-up dental care. Browse doctors by specialty, procedure, service, or equipment to find the best fit for you! 2022 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences. Paper Claim Submission: We use the latest oral health technology and tools so you can feel good about flashing those pearly whites. For member identification, submit the member's 11-digit ID number or the government-assigned identifiers for Medicare or Medical Assistance members. Manage claimssubmit and manage claims entirely online. You can request that your account be reactivated by contacting 1-800-937-0438. These claims are loaded into batches and immediately posted in preparation for adjudication. Your health information, right at your fingertips. Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. Submit claim forms to: Find out how to apply for the Preferred Dentist Program plan detail, and claims. Welcome to UPMC for You! Vision . Visit our secure website, where network providers can sign in and complete most administrative tasks. As a provider-led health insurer, we have a unique appreciation for our relationships with network doctors and care providers. var dayNames = new Array("Sunday","Monday","Tuesday","Wednesday","Thursday","Friday","Saturday"); Pittsburgh, PA 15230-1600. The UPMC Presbyterian Dental Center at UPMC Montefiore offers preventive and follow-up dental care. Find a Doctor or Provider. We also treat serious dental issues to help you keep smiling. Select MyUPMC to access your UPMC health information. Providers submitting claims through So can you. DHMO providers will have the ability to manage all payments under one experience on the Zelis platform in future phases. 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). Start Here. Sign in/Register I am a:MemberProviderEmployerProducer Sign In Please enter your username. First-time users can create an account by contacting their office Provider OnLine Account Administrator or by calling 1-800-937-0438. // Array of day names Providers are able to submit claims directly without incurring clearinghouse expenses. 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 dept. Someone will contact you. At this time, only PPO providers currently receiving their payments by checks will be included in this phase. Find a UPMC health care facility close to you quickly by browsing by region. Dental Care at UPMC Our dental experts can help you to put your best face forward. Log In to the Dental Advantage Provider Portal Announcements Get the latest updates from UPMC Health Plan. Read Dental Announcements . For patients of UPMC-affiliated doctors in Central Pa, select UPMC Central Pa Portal. The portal for UPMC Cole patients receiving inpatient care. Dental . 200 Lothrop Street 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. The portal for UPMC patients in Central Pa. Electronically filed claims may be submitted in the following ways: Individual claim entry Need to schedule by phone? For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. Member Login. For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. For additional information, please call SKYGEN Provider Services at 1-855-806-5193 or email providerservices@skygenusa.com. UPMC Health Plan and SKYGEN Dental Provider Quick Reference Guide. Welcome to MetDental.com. 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. Federal Employees: Federal Employees Health Benefits Program (FEHB) Dental Advantage 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. 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. 2023 MetLife Services and Solutions, LLC, VPoint Credentialing and Recredentialing Services. Interact with the Health Plan on claims issues via a messaging system. Register. MetLife is committed to helping our providers have a smooth transition to our new enrollment solution with as little disruption as possible. Register. 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^. 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. UPMC Health Plan and SKYGEN Clinical Criteria effective 12/18/2022. 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. UPMC Dental Advantage Provider Portal Visit our secure website, where network providers can sign in and complete most administrative tasks. Phone: 1-800-286-4242. Get virtual care Schedule a video visit with your regular provider. Sign in to UPMC Cole Connect Patient Portal. UPMC Health Plan and SKYGEN Product Guide. Medical . UPMC Community HealthChoices Dental Allowance Request Form. First-time users can create a Provider OnLine account. UPMC CCP-South Fayette. Have the ability to download and install a free Active-X secure FTP add-on. Submit claim forms to: This person will: If you have not accessed your Provider OnLine account in the past six months, your account may be disabled. If you can't log in, contact Sales Support at 1-855-862-6515. Not registered with UPMC Health Plan? 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. 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. We offer personalized dental care at UPMC Montefiore in Pittsburgh and UPMC Cole in Coudersport and Port Allegany, Pa. Western Pa. Learn how to get one now. Your Username or Password? The plan is designed to encourage regular preventive care and foster open communication between patients and dentists regarding recommended treatment plans. IN Login/Register. Make Provider OnLine security requests to UPMC Health Plan on behalf of other staff members. // patched for y2k bug! Emdeon should use payer ID 23281. Existing EFT payments set up with MetLife will remain unchanged, so no action is required on your part. Children's Health Insurance Program: UPMC for Kids (CHIP) Dental Advantage We apologize for this inconvenience and look forward to serving you the next time you sign in. View resources for medical providers, log into Provider OnLine, and get access to downloadable forms. Pharmacy . Use billing software that allows the generation of a HIPAA-compliant 837 professional or institutional file. Emdeon should use payer ID 25184. Search adult and pediatric providers and schedule appointments online. Forgot username or password? The portal for all UPMC patients EXCEPT those in Central Pa. To learn how to register, watch our instructional Provider OnLine registration video. 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. Search adult and pediatric providers and schedule appointments online. 800-533-8762. Password: 2599 Wexford Bayne Road, Sewickley, PA 15143 (Map) 724-933-3700. You may search for dentists by zip code, proximity, and type on the provider search tool above for any of the dental options. 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. Your place to stay in control. To learn how to register, watch our instructional Provider OnLine registration video. Claims should be submitted using one of the methods below: Clearinghouse Submission: Were happy to give you more information about becoming a UPMC Dental Advantage provider. Our dental health team at UPMC Cole offers high-quality family dental care at affordable pricing. document.write(dayNames[now.getDay()] + ", " + monthNames[now.getMonth()] + " " + now.getDate() + ", " + year); User name: If you are interested in HIPAA-compliant EDI file submission, please refer to the additional set-up documents on this website. This portion of the UPMC Health Plan's website is strictly related to HIPAA-mandated EDI transactions. 412-647-8762 2022 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences. 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. Browse doctors by specialty, procedure, service, or equipment to find the best fit for you! Message your doctor Send a private, secure message to your provider, anytime. Contact Us Current Members. . Learn about the dental products UPMC Health Plan offers and the variety of resources available to network providers. Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday.
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