To learn how to register, watch our instructional Provider OnLine registration video. We apologize for this inconvenience and look forward to serving you the next time you sign in. Get the latest news and information on the EFT/ERA Overview page in the resource center. Through MetDental, participating Dentists can view rosters, search for Explanation of Payment statements, download Facility Reference Guides, and more. var monthNames = new Array( Browse doctors by specialty, procedure, service, or equipment to find the best fit for you! Chat with a UPMC Health Plan provider service representative in real time. . 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. We use the latest oral health technology and tools so you can feel good about flashing those pearly whites. 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. Login::. - UPMC Your dedicated network manager can answer questions and keep you current on new benefits, features, and products. Sign in ; Register . Batch file submissions Start Here. As a network dentist, youll get help with claims status, eligibility, and more. Account Login | MyUPMC Log In To Your Account Username Password Sign Up Forgot Username? It is important that you respond to VPoint to ensure your continued relationship with MetLife. Our Dental Advantage Newsletter includes the latest news and information for network providers. 1 Childrens Hospital Drive, 4401 Penn Avenue, Floor 7, Pittsburgh, PA 15224 (Map) Children's North Ambulatory Surgery Center. Our provider portal solutions make business transactions fast, simple and convenient, including: Submission of dental claims and prior authorizations . 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. If you need help with your account, please call 1-866-884-8579. 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. 200 Lothrop Street Pittsburgh, PA 15213 412-647-8762 800-533-8762 Learn how to get one now. The portal for UPMC Cole patients receiving inpatient care. DenteMax is one of the largest leasable dental PPO networks in the United States. For Providers About Contact Search. Important: Please provide your National Provider Identifier (NPI) when prompted. Select MyUPMC to access your UPMC health information. Someone will contact you. Access your UPMC information in MyUPMC. Home & Community-Based Services . Call your provider's office or 1-800-533-8762. UPMC Health Plan and SKYGEN Clinical Criteria effective 12/18/2022. We also treat serious dental issues to help you keep smiling. Electronically filed claims may be submitted in the following ways: Individual claim entry // patched for y2k bug! Contact Us Current Members. 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. 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. View resources for medical providers, log into Provider OnLine, and get access to downloadable forms. UPMC Community HealthChoices (CHC) Dental Advantage For technical questions about the UPMC Central PA Portal, contact the Help Desk Mon. 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. IN First-time users can create an account by contacting their office Provider OnLine Account Administrator or by calling 1-800-937-0438. document.write(dayNames[now.getDay()] + ", " + monthNames[now.getMonth()] + " " + now.getDate() + ", " + year); User name: 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^. Paper Claim Submission: Contact Our Dental Benefits Advisory Team, Join our UPMC Dental Advantage Provider Network, ONC 21st Century Cures Act Member Resource Center. For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. To verify eligibility and plan information, please call: Claims and pre-determinations should be submitted using one of the methods below: Clearinghouse Submission: the introduction of UPMC Dental Advantage. Grant access to Provider OnLine to certain staff members on the provider's behalf. Please be advised Zelis is the new payment solution for MetLife claim payments. Find care with UPMC Health Plan's Provider Directory. Forgot username or password? Submission of dental claims and prior authorizations, Member status and eligibility determination. How to Login? More Contact Options ; . Give us feedback on Provider OnLine. For a medical emergency, call 911 or go to the nearest emergency dept. Password: Dental Providers | SKYGEN Paper Claim Submission: Submit claim forms to: UPMC Dental Advantage PO Box 1600 Pittsburgh, PA 15230-1600 800-533-8762. Dental Coverage | UPMC Community HealthChoices For Health Care Providers | UPMC Health Plan Dental . First-time users can create an account by contacting their office Provider OnLine Account Administrator or by calling 1-800-937-0438. Medical . 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. Use billing software that allows the generation of a HIPAA-compliant 837 professional or institutional file. Dental Care at UPMC Our dental experts can help you to put your best face forward. to earn CE credits without leaving the office. Make Provider OnLine security requests to UPMC Health Plan on behalf of other staff members. Your Username or Password? Dental . Interested in joining UPMC Health Plans provider network? First-time users can create a Provider OnLine account. Find listings of the care providers we partner with including doctors, hospitals, pharmacies . 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. Complete testing and become certified with UPMC Health Plan. MyUPMC: Connect to Your UPMC Care Online dental care - Find a Doctor | UPMC If you forgot your User ID or need assistance, please call our Help Desk at 1-800-937-0438. For more information on dental services, view the UPMC Community HealthChoices Handbook . Your health information, right at your fingertips. Sign in to UPMC Cole Connect Patient Portal. The UPMC Presbyterian Dental Center at UPMC Montefiore offers preventive and follow-up dental care. Get the latest updates from UPMC Health Plan. Individual claim entry, known as Prelog, is available to providers with established Health Plan online accounts. Providers submitting claims through // Array of day names plan detail, and claims. MyUPMC: Connect to Your UPMC Care Online Forgot Password? 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. Visit UPMC Health Plan's homepage. 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. Dominion National provides dental plans and administrative services to UPMC Health Plan members and maintains an extensive selection of participating dentists. The portal for UPMC patients in Central Pa. Forgot Claims should be submitted using one of the methods below: Clearinghouse Submission: Discover the advantages of joining, and learn about resources available to you as a network provider. UPMC Community HealthChoices Dental Allowance Request Form. 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. Home & Community-Based Services . Behavioral Health . Submit claim forms to: Were happy to give you more information about becoming a UPMC Dental Advantage provider. Providers. For a medical emergency, call 911 or go to the nearest emergency department. Advantage Dental Provider Portal Need to schedule by phone? UPMC Vision Advantage and UPMC Vision Care* make it easy for you to give your patients high-quality vision care and preventive services. As a network provider, you can: Verify eligibilitycheck plan status with a member's ID, full name, and date of birth. Need Help? View UPMC's other Patient Portals. Read Dental Announcements Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. Search adult and pediatric providers and schedule appointments online. Log In to the Dental Advantage Provider Portal Announcements Get the latest updates from UPMC Health Plan. 205 Millers Run Road, Suite 300, Bridgeville, PA 15017 (Map) 724-934-3334. About the Electronic Remittance Advice Please use the following link to return to the UPMC Health Plan home pageUPMC Health Plan home page At this time, only PPO providers currently receiving their payments by checks will be included in this phase. Access formsfind provider manuals, plan sheets, lab program forms . *Disclaimer: This online directory provides a list of UPMC Health Plan providers, and the information contained here is updated periodically. Online Login: UserID I forgot my user id (Members Only) : There was an error with the Pass through from your Public Website. This person will: If you have not accessed your Provider OnLine account in the past six months, your account may be disabled. I am a: Login. Find care with UPMC Health Plan's Provider Directory. Medical Assistance: 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. For Medical Providers | UPMC Health Plan Patients of UPMC Cole should select the UPMC Cole Connect Patient Portal. Resources for Medical Providers Dental Providers Learn about the dental products UPMC Health Plan offers and the variety of resources available to network providers. Interact with the Health Plan on claims issues via a messaging system. 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. 2022 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences. Not registered with UPMC Health Plan? 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). var now = new Date(); If you can't log in, contact Sales Support at 1-855-862-6515. How to Login? You may search for dentists by zip code, proximity, and type on the provider search tool above for any of the dental options. So many helpful features. 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. Find a Doctor or Provider. Please be advised MetLife has contracted VPoint to provide credentialing and recredentialing services on MetLife's behalf. Children's Health Insurance Program: UPMC for Kids (CHIP) Dental Advantage For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. For a medical emergency, call 911 or go to the nearest emergency dept. Login/Register. UPMC Dental Advantage Learn about and take advantage of the resources available to you as a network provider. For Providers About Contact . In order to submit EDI files directly to the Health Plan, providers must: UPMC Health Plan currently accepts dual provider identifiers. Login/Register. TTY: 711. Claim files are transmitted using a secure FTP process that does not require data encryption prior to transmission. var dayNames = new Array("Sunday","Monday","Tuesday","Wednesday","Thursday","Friday","Saturday"); Our Provider Partner Update 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. For a medical emergency, call 911 or go to the nearest emergency department. UPMC Health Plan and SKYGEN Dental Provider Quick Reference Guide. If you are interested in HIPAA-compliant EDI file submission, please refer to the additional set-up documents on this website. Register. You can request that your account be reactivated by contacting 1-800-937-0438. View resources for medical providers, log into Provider OnLine, and get access to downloadable forms. UPMC CCP-South Fayette. As a provider-led health insurer, we have a unique appreciation for our relationships with network doctors and care providers. Medicare Special Needs Plans: UPMC for Life Complete Care Dental Advantage. through Fri., 8 a.m. to 5 p.m. at 1-888-782-5678 or 717-988-0000 press 6 If you forgot your user ID or need assistance, please call our Help Desk at 1-800-937-0438. Federal Employees: Federal Employees Health Benefits Program (FEHB) Dental Advantage Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. Make an appointment SIGN Forgot username or password? Here you can explore resources and information about Medical Assistance coverage and benefits. Find care with UPMC Health Plan's Provider Directory. 2022 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences. Get the latest resources, news, and announcements from UPMC Health Plan for participating providers. MetLife is committed to helping our providers have a smooth transition to our new enrollment solution with as little disruption as possible. Learn about the dental products UPMC Health Plan offers and the variety of resources available to network providers. Patients of UPMC Cole should select the UPMC Cole Connect Patient Portal. Need to schedule by phone? For Dental Providers | UPMC Health Plan The Act creates specific negotiation and dispute resolution protocols between payer and provider. Our dental health team at UPMC Cole offers high-quality family dental care at affordable pricing. dental care - Find a Doctor | UPMC Dentistry - Find a Doctor | UPMC Provider Directory | Find Care | UPMC Health Plan I am a: Login. Phone: 1-800-286-4242. 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. 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. Your Username or Password? Existing EFT payments set up with MetLife will remain unchanged, so no action is required on your part. *Administered by National Vision Administrators, Join our UPMC Dental Advantage Provider Network, ONC 21st Century Cures Act Member Resource Center. As a participating provider, you can access valuable information online by entering your user ID and password in the login box on this page. . Provider Directory | Find Care | UPMC Health Plan 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. These clearinghouses are then responsible for reformatting these claims to meet HIPAA standards and passing the claims on to the Health Plan. Member Login. Register. 2599 Wexford Bayne Road, Sewickley, PA 15143 (Map) 724-933-3700. Find out how to apply for the Preferred Dentist Program Find a UPMC health care facility close to you quickly by browsing by region. For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. In the meantime, if you need to verify eligibility, plan information or submit a claim, please follow the instructions below. Learn more about our plans and programs, find a dentist, or sign in to view patient eligibility, plan detail, and claims. Via the Provider OnLine EDI tools, these batches can be viewed in several standard report formats. UPMC Dental Advantage Provider Portal Visit our secure website, where network providers can sign in and complete most administrative tasks. Search adult and pediatric providers and schedule appointments online. View plansget vision and dental plan information prior to the member's visit. UPMC Health Plan accepts electronic claims in data file transmissions. The portal for all UPMC patients EXCEPT those in Central Pa. // Array of month Names Medicare: UPMC for Life Dental Advantage (University of Pittsburgh retirees only) 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. Login/Register. Search adult and pediatric providers and schedule appointments online. So can you. We offer personalized dental care at UPMC Montefiore in Pittsburgh and UPMC Cole in Coudersport and Port Allegany, Pa. Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. Find out how to apply for Dental HMO/Managed Care Plan^. Get the latest news and information about the Dental HMO/Managed Care Network^ and Products. 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. For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. Dentists in our network enjoy top-notch support that makes it easier to run a successful practice. UPMC for You Dental Advantage for a doctor or specialist. To learn more, visit healthwise.org. var year = now.getFullYear() UPMC Central PA Portal - Login Page Login - UPMC Manage claimssubmit and manage claims entirely online. 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! UPMC Health Plan's Provider OnLine. - Health Plan Member Login Video Visit. Thank you for being a part of the UPMC Dental Advantage/UPMC Vision Advantage network. DenteMax | DenteMax Dental PPO Network Pharmacy . Providers submitting claims through 2023 MetLife Services and Solutions, LLC, VPoint Credentialing and Recredentialing Services. Emdeon should use payer ID 25184. For additional information, please call SKYGEN Provider Services at 1-855-806-5193 or email providerservices@skygenusa.com. 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. With UPMC Health Plan's Provider OnLine, you can: A provider office should appoint a staff member to serve as Security Officer. If you need assistance, please call our Help Desk at 1-800-937-0438. . Provider OnLine Features With UPMC Health Plan's Provider OnLine, you can: Our dental experts can help you to put your best face forward. Vision . Forgot username or password? For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. We offer personalized dental care at UPMC Montefiore in Pittsburgh and UPMC Cole in Coudersport and Port Allegany, Pa. Western Pa. UPMC Health Plan Members | Dominion National UPMC Dental Advantage offers competitive rates, convenient tools, and rapid reimbursement. DHMO providers will continue to receive paper checks and/or EFT payments as they do today, no action is required for DHMO payments. . User Login. Login This application is best viewed using Internet Explorer versions 6.0 and higher Login As Provider Network Login Name Password Home Forgot Password? Your place to stay in control. 200 Lothrop Street 2023 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences, Supplemental content provided by Healthwise, Incorporated. For Providers About Contact . Find Dental Care Near You | UPMC Search adult and pediatric providers and schedule appointments online. PDF UPMC Dental Advantage Please sign in to view patient eligibility, Pittsburgh, PA 15230-1600. UPMC Health Plan and SKYGEN Product Guide. It requires the recipient's Practice or Billing System have the ability to automate loading of a file in the mandated format. UPMC Health Plan and SKYGEN Provider Manual. Resources for UPMC Health Plan/SKYGEN Dental Providers. View up-to-date eligibility, PCP information, and covered benefits. Register. I am a: Login. Providers may use the standard PGP encryption process in addition to the secure FTP, if additional data security is desired. Find a Doctor or Provider - Provider Directory | Find Care | UPMC Resources for UPMC Health Plan/SKYGEN Dental Providers If you choose this option for claims submission and you do not have a Provider OnLine account, complete this form to sign up. Paper Claim Submission: Health Plan Member Login Need to schedule by phone? UPMC Vision Advantage Forgot Find out how Determine a patient's primary insurance coverage. MetDental.com For Providers | UPMC Community HealthChoices 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. The online provider search lets you find a person who provides . When care is coordinated, submit the referring provider NPI if available, as well as the name and UPIN. Message your doctor Send a private, secure message to your provider, anytime. Resources for Dental Providers Vision Providers Please submit the National Provider Identifier (NPI), along with the tax ID and the provider ID as assigned by UPMC Health Plan. For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. Thousands of CE credits awarded online. You also can register to join the network. Welcome to MetDental.com. Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. Not registered with UPMC Health Plan? Dental and Vision Providers - UPMC Health Plan 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. Our provider portal is currently unavailable. You also can register to join the network. Login to Provider Online. Have a sample 837 file exported from their billing system containing only UPMC Health Plan claims. Medicaid and Medical Assistance Plans | UPMC for You First-time users can create a Provider OnLine account. Need to schedule by phone? To learn how to register, watch our instructional Provider OnLine registration video. Providers are able to submit claims directly without incurring clearinghouse expenses.