MetLife is committed to helping our providers have a smooth transition to our new enrollment solution with as little disruption as possible. Interact with the Health Plan on claims issues via a messaging system. Get the latest news and information about the Dental HMO/Managed Care Network^ and Products. First-time users can create an account by contacting their office Provider OnLine Account Administrator or by calling 1-800-937-0438. Our provider portal is currently unavailable. Patients of UPMC Cole should select the UPMC Cole Connect Patient Portal. Dentists in our network enjoy top-notch support that makes it easier to run a successful practice. 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 technical questions about the UPMC Central PA Portal, contact the Help Desk Mon. Read Dental Announcements UPMC Dental Advantage // Array of month Names The UPMC Presbyterian Dental Center at UPMC Montefiore offers preventive and follow-up dental care. 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. For Providers About Contact . Browse doctors by specialty, procedure, service, or equipment to find the best fit for you! Browse doctors by specialty, procedure, service, or equipment to find the best fit for you! For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. Thank you for being a part of the UPMC Dental Advantage/UPMC Vision Advantage network. Get the latest news and information on the EFT/ERA Overview page in the resource center. Were happy to give you more information about becoming a UPMC Dental Advantage provider. Discover the advantages of joining, and learn about resources available to you as a network provider. Find a UPMC health care facility close to you quickly by browsing by region. Find care with UPMC Health Plan's Provider Directory. var now = new Date(); Please submit the National Provider Identifier (NPI), along with the tax ID and the provider ID as assigned by UPMC Health Plan. PO Box 1600 Sign in/Register I am a:MemberProviderEmployerProducer Sign In Please enter your username. 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. Our provider portal solutions make business transactions fast, simple and convenient, including: Submission of dental claims and prior authorizations . Pittsburgh, PA 15230-1600. Login/Register. Register. document.write(dayNames[now.getDay()] + ", " + monthNames[now.getMonth()] + " " + now.getDate() + ", " + year); User name: Vision . UPMC Health Plan and SKYGEN Clinical Criteria effective 12/18/2022. For a medical emergency, call 911 or go to the nearest emergency dept. Sign in to UPMC Cole Connect Patient Portal. Sign in ; Register . Search adult and pediatric providers and schedule appointments online. Via the Provider OnLine EDI tools, these batches can be viewed in several standard report formats. As a provider-led health insurer, we have a unique appreciation for our relationships with network doctors and care providers. SIGN It requires the recipient's Practice or Billing System have the ability to automate loading of a file in the mandated format. 2599 Wexford Bayne Road, Sewickley, PA 15143 (Map) 724-933-3700. Determine a patient's primary insurance coverage. Learn about and take advantage of the resources available to you as a network provider. So many helpful features. For a medical emergency, call 911 or go to the nearest emergency department. The online provider search lets you find a person who provides . Have a sample 837 file exported from their billing system containing only UPMC Health Plan claims. For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. You can follow up with additional questions to the HealthPlanEDI@upmc.edu distribution group. var dayNames = new Array("Sunday","Monday","Tuesday","Wednesday","Thursday","Friday","Saturday"); 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. Emdeon should use payer ID 23281. Please be advised MetLife has contracted VPoint to provide credentialing and recredentialing services on MetLife's behalf. For patients of UPMC-affiliated doctors in Central Pa, select UPMC Central Pa Portal. Your health information, right at your fingertips. The portal for UPMC patients in Central Pa. The provider's office can enter claims and verify if they have been accepted and are ready for adjudication. For a medical emergency, call 911 or go to the nearest emergency department. To learn how to register, watch our instructional Provider OnLine registration video. Existing EFT payments set up with MetLife will remain unchanged, so no action is required on your part. About the Electronic Remittance Advice If you need assistance, please call our Help Desk at 1-800-937-0438. Learn about the dental products UPMC Health Plan offers and the variety of resources available to network providers. 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. Electronically filed claims may be submitted in the following ways: Individual claim entry Providers may use the standard PGP encryption process in addition to the secure FTP, if additional data security is desired. Welcome to MetDental.com. We offer personalized dental care at UPMC Montefiore in Pittsburgh and UPMC Cole in Coudersport and Port Allegany, Pa. Western Pa. Important: Please provide your National Provider Identifier (NPI) when prompted. Not a UPMC Central PA Portal Patient? Find listings of the care providers we partner with including doctors, hospitals, pharmacies . Not registered with UPMC Health Plan? Complete testing and become certified with UPMC Health Plan. Dentistry - Find a Doctor | UPMC Need Care? I am a: Login. 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. 200 Lothrop Street 1 Childrens Hospital Drive, 4401 Penn Avenue, Floor 7, Pittsburgh, PA 15224 (Map) Children's North Ambulatory Surgery Center. For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. Pittsburgh, PA 15230-1600, Join our UPMC Dental Advantage Provider Network, ONC 21st Century Cures Act Member Resource Center. Medical Assistance: Interested in joining UPMC Health Plans provider network? "January","February","March","April","May","June","July","August","September","October","November","December"); If you have questions while you are completing the form, contact our Web Support Services at 1-800-937-0438. Providers submitting claims through Need Help? For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. Search adult and pediatric providers and schedule appointments online. 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. Patients of UPMC Cole should select the 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. Select MyUPMC to access your UPMC health information. 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. 2023 MetLife Services and Solutions, LLC, VPoint Credentialing and Recredentialing Services. We apologize for this inconvenience and look forward to serving you the next time you sign in. As a participating provider, you can access valuable information online by entering your user ID and password in the login box on this page. 800-533-8762. UPMC Health Plan accepts electronic claims in data file transmissions. *Administered by National Vision Administrators, Join our UPMC Dental Advantage Provider Network, ONC 21st Century Cures Act Member Resource Center. Medicare: UPMC for Life Dental Advantage (University of Pittsburgh retirees only) to earn CE credits without leaving the office. In the meantime, if you need to verify eligibility, plan information or submit a claim, please follow the instructions below. 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. Get the latest updates from UPMC Health Plan. Paper Claim Submission: Please sign in to view patient eligibility, View up-to-date eligibility, PCP information, and covered benefits. You also can register to join the network. Start Here. UPMC Health Plan and SKYGEN Provider Manual. 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. How to Login? Submission of dental claims and prior authorizations, Member status and eligibility determination. If you forgot your User ID or need assistance, please call our Help Desk at 1-800-937-0438. Submit claim forms to: You can request that your account be reactivated by contacting 1-800-937-0438. Children's Health Insurance Program: UPMC for Kids (CHIP) Dental Advantage 2022 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences. Medical . Learn how to get one now. User Login. For additional information, please call SKYGEN Provider Services at 1-855-806-5193 or email providerservices@skygenusa.com. UPMC Dental Advantage Provider Portal Visit our secure website, where network providers can sign in and complete most administrative tasks. 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. 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. Make Provider OnLine security requests to UPMC Health Plan on behalf of other staff members. Call your provider's office or 1-800-533-8762. 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 username or password? We offer personalized dental care at UPMC Montefiore in Pittsburgh and UPMC Cole in Coudersport and Port Allegany, Pa. // patched for y2k bug! *Disclaimer: This online directory provides a list of UPMC Health Plan providers, and the information contained here is updated periodically. 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. Your session has ended, thank you for using UPMC Health Plan OnLine. Providers submitting claims through Login This application is best viewed using Internet Explorer versions 6.0 and higher Login As Provider Network Login Name Password Home Forgot Password? The UPMC Presbyterian Dental Center at UPMC Montefiore offers preventive and follow-up dental care. Find out how These claims are loaded into batches and immediately posted in preparation for adjudication. Here you can explore resources and information about Medical Assistance coverage and benefits. Submit claim forms to: Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. The portal for all UPMC patients EXCEPT those in Central Pa. Make an appointment Online Login: UserID I forgot my user id (Members Only) : There was an error with the Pass through from your Public Website. Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. Don't have one? Contact Us Current Members. We use the latest oral health technology and tools so you can feel good about flashing those pearly whites. UPMC Dental Advantage offers UPMC employees two options Standard and Premium with a network of fully credentialed dentists. Chat with a UPMC Health Plan provider service representative in real time. Need to schedule by phone? Not registered with UPMC Health Plan? Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. I am a: Login. Forgot username or password? Claim files are transmitted using a secure FTP process that does not require data encryption prior to transmission. 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. Search adult and pediatric providers and schedule appointments online. 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. Individual claim entry, known as Prelog, is available to providers with established Health Plan online accounts. 412-647-8762 Need to schedule by phone? First-time users can create a Provider OnLine account. For Providers About Contact Search. 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. 200 Lothrop Street Pittsburgh, PA 15213 412-647-8762 800-533-8762 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. It is important that you respond to VPoint to ensure your continued relationship with MetLife. Register. For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. Thousands of CE credits awarded online. To learn how to register, watch our instructional Provider OnLine registration video. 2022 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences. UPMC Health Plan and SKYGEN Dental Provider Quick Reference Guide. Our Dental Benefits Advisory Team is ready to answer your call. Advantage Dental Provider Portal We have moved! Pharmacy . To verify eligibility and plan information, please call: Claims and pre-determinations should be submitted using one of the methods below: Clearinghouse Submission: Start Here. Login to Provider Online. Search adult and pediatric providers and schedule appointments online. Find a Doctor or Provider. Forgot Receive 24-hour access to claims and coverage information. Claims should be submitted using one of the methods below: Clearinghouse Submission: Home & Community-Based Services . Use billing software that allows the generation of a HIPAA-compliant 837 professional or institutional file. Find care with UPMC Health Plan's Provider Directory. Password: I am a: Login. . You also can register to join the network. This person will: If you have not accessed your Provider OnLine account in the past six months, your account may be disabled. Visit UPMC Health Plan's homepage. For a medical emergency, call 911 or go to the nearest emergency department. Login/Register. The plan is designed to encourage regular preventive care and foster open communication between patients and dentists regarding recommended treatment plans. For general assistance or inquiries regarding web portals or logins, please contact us here. DHMO providers will continue to receive paper checks and/or EFT payments as they do today, no action is required for DHMO payments. Find out how to apply for the Preferred Dentist Program Our Provider Partner Update newsletter includes the latest news and information for network providers. If you choose this option for claims submission and you do not have a Provider OnLine account, complete this form to sign up. Dental Care at UPMC Our dental experts can help you to put your best face forward. Your Username or Password? Resources for Dental Providers Vision Providers UPMC Vision Advantage Get the latest resources, news, and announcements from UPMC Health Plan for participating providers. 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. IN Paper Claim Submission: Submit claim forms to: UPMC Dental Advantage PO Box 1600 Pittsburgh, PA 15230-1600 through Fri., 8 a.m. to 5 p.m. at 1-888-782-5678 or 717-988-0000 press 6 As a participating provider, you can access valuable information via Provider OnLine. As a participating provider, you can access valuable information online by entering your user ID and password in the login box on this page. var monthNames = new Array( View resources for medical providers, log into Provider OnLine, and get access to downloadable forms. 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. Need to schedule by phone? Emdeon should use payer ID 25184. Get an immediate response if mistakes are made submitting a claim (using HIPAA 837 forms). Give us feedback on Provider OnLine. We also treat serious dental issues to help you keep smiling. Visit our secure website, where network providers can sign in and complete most administrative tasks. More Contact Options ; . For more information on dental services, view the UPMC Community HealthChoices Handbook . Our Dental Advantage Newsletter includes the latest news and information for network providers. These clearinghouses are then responsible for reformatting these claims to meet HIPAA standards and passing the claims on to the Health Plan. UPMC CCP-South Fayette. Log In to the Dental Advantage Provider Portal Announcements Get the latest updates from UPMC Health Plan. Phone: 1-800-286-4242. 2023 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences, Supplemental content provided by Healthwise, Incorporated. 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^. View plansget vision and dental plan information prior to the member's visit. Announcements Account Login | MyUPMC Log In To Your Account Username Password Sign Up Forgot Username? For a medical emergency, call 911 or go to the nearest emergency department. If you are interested in HIPAA-compliant EDI file submission, please refer to the additional set-up documents on this website. For Providers About Contact . For a medical emergency, call 911 or go to the nearest emergency department. Your place to stay in control. This portion of the UPMC Health Plan's website is strictly related to HIPAA-mandated EDI transactions. At this time, only PPO providers currently receiving their payments by checks will be included in this phase. UPMC Community HealthChoices (CHC) Dental Advantage Find out how to apply for Dental HMO/Managed Care Plan^. Federal Employees: Federal Employees Health Benefits Program (FEHB) Dental Advantage For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. Serve as the provider practices primary contact with UPMC Health Plan regarding Provider OnLine security issues. 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. Please be advised Zelis is the new payment solution for MetLife claim payments. First-time users can create a Provider OnLine account. Your dedicated network manager can answer questions and keep you current on new benefits, features, and products. These resources, such as the Provider Manual, can assist you with administrative and practice needs. Need to schedule by phone? Message your doctor Send a private, secure message to your provider, anytime. PO Box 1600 UPMC Dental Advantage offers competitive rates, convenient tools, and rapid reimbursement. Get virtual care Schedule a video visit with your regular provider. For a medical emergency, call 911 or go to the nearest emergency dept. Resources for Medical Providers Dental Providers Learn about the dental products UPMC Health Plan offers and the variety of resources available to network providers. As a network provider, you can: Verify eligibilitycheck plan status with a member's ID, full name, and date of birth. Paper Claim Submission: Batch file submissions Register. First-time users can create an account by contacting their office Provider OnLine Account Administrator or by calling 1-800-937-0438. To learn more, visit healthwise.org. Forgot Password? Learn more about our plans and programs, find a dentist, or sign in to view patient eligibility, plan detail, and claims. Forgot username or password? Forgot Medicare Special Needs Plans: UPMC for Life Complete Care Dental Advantage. plan detail, and claims. UPMC Health Plan and SKYGEN Product Guide. DenteMax is one of the largest leasable dental PPO networks in the United States. 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. Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. Forgot username or password? Login This application is best viewed using Internet Explorer versions 6.0 and higher Login As Provider Network Login Name Password Home Forgot Password? When care is coordinated, submit the referring provider NPI if available, as well as the name and UPIN. Providers are able to submit claims directly without incurring clearinghouse expenses. 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. // Array of day names Manage claimssubmit and manage claims entirely online. Our dental experts can help you to put your best face forward. 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. Login/Register. Behavioral Health . Dental . Browse doctors by specialty, procedure, service, or equipment to find the best fit for you! Someone will contact you. If you need help with your account, please call 1-866-884-8579. As a network dentist, youll get help with claims status, eligibility, and more. Home & Community-Based Services . View UPMC's other Patient Portals.
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