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Learn about and take advantage of the resources available to you as a network provider. View UPMC's other Patient Portals. This person will: If you have not accessed your Provider OnLine account in the past six months, your account may be disabled. Someone will contact you. If you forgot your User ID or need assistance, please call our Help Desk at 1-800-937-0438. Chat with a UPMC Health Plan provider service representative in real time. For more information on dental services, view the UPMC Community HealthChoices Handbook . Resources for Dental Providers Vision Providers 2022 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences. Login/Register. Individual claim entry, known as Prelog, is available to providers with established Health Plan online accounts. Call your provider's office or 1-800-533-8762. Login/Register. Search adult and pediatric providers and schedule appointments online. Children's Health Insurance Program: UPMC for Kids (CHIP) Dental Advantage for a doctor or specialist. Make an appointment Find care with UPMC Health Plan's Provider Directory. Interact with the Health Plan on claims issues via a messaging system. Get the latest resources, news, and announcements from UPMC Health Plan for participating providers. Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. You can follow up with additional questions to the HealthPlanEDI@upmc.edu distribution group. Through MetDental, participating Dentists can view rosters, search for Explanation of Payment statements, download Facility Reference Guides, and more. Account Login | MyUPMC Log In To Your Account Username Password Sign Up Forgot Username? Providers. Resources for UPMC Health Plan/SKYGEN Dental Providers. through Fri., 8 a.m. to 5 p.m. at 1-888-782-5678 or 717-988-0000 press 6 Need to schedule by phone? Login This application is best viewed using Internet Explorer versions 6.0 and higher Login As Provider Network Login Name Password Home Forgot Password? Select MyUPMC to access your UPMC health information. Behavioral Health . Have the ability to download and install a free Active-X secure FTP add-on. Our provider portal is currently unavailable. Get an immediate response if mistakes are made submitting a claim (using HIPAA 837 forms). For a medical emergency, call 911 or go to the nearest emergency department. 200 Lothrop Street Pittsburgh, PA 15213 412-647-8762 800-533-8762 If you choose this option for claims submission and you do not have a Provider OnLine account, complete this form to sign up. 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). 412-647-8762 As a network dentist, youll get help with claims status, eligibility, and more. First-time users can create an account by contacting their office Provider OnLine Account Administrator or by calling 1-800-937-0438. Search adult and pediatric providers and schedule appointments online. Visit our secure website, where network providers can sign in and complete most administrative tasks. SIGN 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. Commercial and Medicare Dominion National provides dental plans and administrative services to UPMC Health Plan members and maintains an extensive selection of participating dentists. Your Username or Password? TTY: 711. In the meantime, if you need to verify eligibility, plan information or submit a claim, please follow the instructions below. If you need help with your account, please call 1-866-884-8579. Login This application is best viewed using Internet Explorer versions 6.0 and higher Login As Provider Network Login Name Password Home Forgot Password? var now = new Date(); We use the latest oral health technology and tools so you can feel good about flashing those pearly whites. View resources for medical providers, log into Provider OnLine, and get access to downloadable forms. You may search for dentists by zip code, proximity, and type on the provider search tool above for any of the dental options. Our provider portal solutions make business transactions fast, simple and convenient, including: Submission of dental claims and prior authorizations . Forgot username or password? Our Provider Partner Update newsletter includes the latest news and information for network providers. Serve as the provider practices primary contact with UPMC Health Plan regarding Provider OnLine security issues. Providers submitting claims through We apologize for this inconvenience and look forward to serving you the next time you sign in. Providers may use the standard PGP encryption process in addition to the secure FTP, if additional data security is desired. Batch file submissions UPMC CCP-South Fayette. So can you. 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. As a provider-led health insurer, we have a unique appreciation for our relationships with network doctors and care providers. Learn more about our plans and programs, find a dentist, or sign in to view patient eligibility, plan detail, and claims. 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. As a participating provider, you can access valuable information online by entering your user ID and password in the login box on this page. *Administered by National Vision Administrators, Join our UPMC Dental Advantage Provider Network, ONC 21st Century Cures Act Member Resource Center. For a medical emergency, call 911 or go to the nearest emergency department. UPMC Health Plan and SKYGEN Product Guide. Browse doctors by specialty, procedure, service, or equipment to find the best fit for you! UPMC Dental Advantage offers UPMC employees two options Standard and Premium with a network of fully credentialed dentists. Not registered with UPMC Health Plan? Please sign in to view patient eligibility, DHMO providers will have the ability to manage all payments under one experience on the Zelis platform in future phases. Medical . 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. UPMC Vision Advantage and UPMC Vision Care* make it easy for you to give your patients high-quality vision care and preventive services. Dental . We also treat serious dental issues to help you keep smiling. Forgot Password? Find listings of the care providers we partner with including doctors, hospitals, pharmacies . UPMC Health Plan and SKYGEN Provider Manual. Find care with UPMC Health Plan's Provider Directory. UPMC Health Plan accepts electronic claims in data file transmissions. Need to schedule by phone? Find a Doctor or Provider. 1 Childrens Hospital Drive, 4401 Penn Avenue, Floor 7, Pittsburgh, PA 15224 (Map) Children's North Ambulatory Surgery Center. Grant access to Provider OnLine to certain staff members on the provider's behalf. Federal Employees: Federal Employees Health Benefits Program (FEHB) Dental Advantage plan detail, and claims. 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^. Medicare Special Needs Plans: UPMC for Life Complete Care Dental Advantage. Existing EFT payments set up with MetLife will remain unchanged, so no action is required on your part. Please use the following link to return to the UPMC Health Plan home pageUPMC Health Plan home page Resources for Medical Providers Dental Providers Learn about the dental products UPMC Health Plan offers and the variety of resources available to network providers. Forgot username or password? Dental . . Phone: 1-800-286-4242. Your health information, right at your fingertips. Provider OnLine Features With UPMC Health Plan's Provider OnLine, you can: 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. If you need assistance, please call our Help Desk at 1-800-937-0438. For member identification, submit the member's 11-digit ID number or the government-assigned identifiers for Medicare or Medical Assistance members. Sign in to UPMC Cole Connect Patient Portal. Contact Our Dental Benefits Advisory Team, Join our UPMC Dental Advantage Provider Network, ONC 21st Century Cures Act Member Resource Center. Visit UPMC Health Plan's homepage. Get the latest updates from UPMC Health Plan. Not a UPMC Central PA Portal Patient? Claim files are transmitted using a secure FTP process that does not require data encryption prior to transmission. These resources, such as the Provider Manual, can assist you with administrative and practice needs. Welcome to MetDental.com. You also can register to join the network. Have a sample 837 file exported from their billing system containing only UPMC Health Plan claims. Start Here. 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. Thank you for being a part of the UPMC Dental Advantage/UPMC Vision Advantage network. I am a: Login. Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. var monthNames = new Array( This portion of the UPMC Health Plan's website is strictly related to HIPAA-mandated EDI transactions. 2022 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences. Emdeon should use payer ID 23281. Important: Please provide your National Provider Identifier (NPI) when prompted. DHMO providers will continue to receive paper checks and/or EFT payments as they do today, no action is required for DHMO payments. 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. Vision . Here you can explore resources and information about Medical Assistance coverage and benefits. Medicare: UPMC for Life Dental Advantage (University of Pittsburgh retirees only) var year = now.getFullYear() Use billing software that allows the generation of a HIPAA-compliant 837 professional or institutional file. Receive 24-hour access to claims and coverage information. Video Visit. Thousands of CE credits awarded online. Your Username or Password? 2022 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences. // Array of day names *Disclaimer: This online directory provides a list of UPMC Health Plan providers, and the information contained here is updated periodically. 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. Contact Us Current Members. Online Login: UserID I forgot my user id (Members Only) : There was an error with the Pass through from your Public Website. Access formsfind provider manuals, plan sheets, lab program forms . 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. As a network provider, you can: Verify eligibilitycheck plan status with a member's ID, full name, and date of birth. "January","February","March","April","May","June","July","August","September","October","November","December"); View plansget vision and dental plan information prior to the member's visit. 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. // patched for y2k bug! It requires the recipient's Practice or Billing System have the ability to automate loading of a file in the mandated format. DenteMax is one of the largest leasable dental PPO networks in the United States. Register. For a medical emergency, call 911 or go to the nearest emergency department. 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 Health Plan and SKYGEN Clinical Criteria effective 12/18/2022. 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