DHMO providers will continue to receive paper checks and/or EFT payments as they do today, no action is required for DHMO payments. Our Provider Partner Update newsletter includes the latest news and information for network providers. 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). Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. Pittsburgh, PA 15230-1600, Join our UPMC Dental Advantage Provider Network, ONC 21st Century Cures Act Member Resource Center. Sign in/Register I am a:MemberProviderEmployerProducer Sign In Please enter your username. 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. Via the Provider OnLine EDI tools, these batches can be viewed in several standard report formats. At this time, only PPO providers currently receiving their payments by checks will be included in this phase. Dominion National provides dental plans and administrative services to UPMC Health Plan members and maintains an extensive selection of participating dentists. . I am a: Login. 1 Childrens Hospital Drive, 4401 Penn Avenue, Floor 7, Pittsburgh, PA 15224 (Map) Children's North Ambulatory Surgery Center. Forgot username or password? To learn how to register, watch our instructional Provider OnLine registration video. Need to schedule by phone? Contact Us Current Members. Give us feedback on Provider OnLine. To learn how to register, watch our instructional Provider OnLine registration video. Announcements In the meantime, if you need to verify eligibility, plan information or submit a claim, please follow the instructions below. If you need assistance, please call our Help Desk at 1-800-937-0438. Forgot Password? Access your UPMC information in MyUPMC. View resources for medical providers, log into Provider OnLine, and get access to downloadable forms. 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. Member Login. UPMC CCP-South Fayette. Pharmacy . Register. View UPMC's other Patient Portals. Read Dental Announcements Resources for Medical Providers Dental Providers Learn about the dental products UPMC Health Plan offers and the variety of resources available to network providers. For patients of UPMC-affiliated doctors in Central Pa, select UPMC Central Pa Portal. View up-to-date eligibility, PCP information, and covered benefits. Find a Doctor or Provider. Our dental experts can help you to put your best face forward. Home & Community-Based Services . Search adult and pediatric providers and schedule appointments online. It is important that you respond to VPoint to ensure your continued relationship with MetLife. Forgot username or password? Here you can explore resources and information about Medical Assistance coverage and benefits. Pittsburgh, PA 15230-1600. Existing EFT payments set up with MetLife will remain unchanged, so no action is required on your part. Have the ability to download and install a free Active-X secure FTP add-on. How to Login? Don't have one? Call your provider's office or 1-800-533-8762. Online Login: UserID I forgot my user id (Members Only) : There was an error with the Pass through from your Public Website. View resources for medical providers, log into Provider OnLine, and get access to downloadable forms. UPMC Health Plan and SKYGEN Provider Manual. Children's Health Insurance Program: UPMC for Kids (CHIP) Dental Advantage The portal for UPMC Cole patients receiving inpatient care. Welcome to MetDental.com. DenteMax is one of the largest leasable dental PPO networks in the United States. For a medical emergency, call 911 or go to the nearest emergency department. Learn about the dental products UPMC Health Plan offers and the variety of resources available to network providers. Forgot username or password? Medicare Special Needs Plans: UPMC for Life Complete Care Dental Advantage. As a provider-led health insurer, we have a unique appreciation for our relationships with network doctors and care providers. UPMC Vision Advantage and UPMC Vision Care* make it easy for you to give your patients high-quality vision care and preventive services. To learn more, visit healthwise.org. Dental . Emdeon should use payer ID 23281. Chat with a UPMC Health Plan provider service representative in real time. 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. With UPMC Health Plan's Provider OnLine, you can: A provider office should appoint a staff member to serve as Security Officer. Paper Claim Submission: Browse doctors by specialty, procedure, service, or equipment to find the best fit for you! 412-647-8762 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. Important: Please provide your National Provider Identifier (NPI) when prompted. UPMC Dental Advantage offers competitive rates, convenient tools, and rapid reimbursement. As a network dentist, youll get help with claims status, eligibility, and more. Your health information, right at your fingertips. Paper Claim Submission: Submit claim forms to: UPMC Dental Advantage PO Box 1600 Pittsburgh, PA 15230-1600 Electronically filed claims may be submitted in the following ways: Individual claim entry To verify eligibility and plan information, please call: Claims and pre-determinations should be submitted using one of the methods below: Clearinghouse Submission: Browse doctors by specialty, procedure, service, or equipment to find the best fit for you! Medicare: UPMC for Life Dental Advantage (University of Pittsburgh retirees only) These resources, such as the Provider Manual, can assist you with administrative and practice needs. For a medical emergency, call 911 or go to the nearest emergency dept. In order to submit EDI files directly to the Health Plan, providers must: UPMC Health Plan currently accepts dual provider identifiers. Advantage Dental Provider Portal We have moved! Download a form for your practice, update your profile, or learn how to report fraud and abuse. Need to schedule by phone? The portal for all UPMC patients EXCEPT those in Central Pa. Providers are able to submit claims directly without incurring clearinghouse expenses. Please sign in to view patient eligibility, Batch file submissions Forgot Interact with the Health Plan on claims issues via a messaging system. . UPMC Dental Advantage offers UPMC employees two options Standard and Premium with a network of fully credentialed dentists. through Fri., 8 a.m. to 5 p.m. at 1-888-782-5678 or 717-988-0000 press 6 Your Username or Password? Your dedicated network manager can answer questions and keep you current on new benefits, features, and products. Sign in to UPMC Cole Connect Patient Portal. Providers submitting claims through document.write(dayNames[now.getDay()] + ", " + monthNames[now.getMonth()] + " " + now.getDate() + ", " + year); User name: First-time users can create an account by contacting their office Provider OnLine Account Administrator or by calling 1-800-937-0438. 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. Pittsburgh, PA 15213 Account Login | MyUPMC Log In To Your Account Username Password Sign Up Forgot Username? Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. Browse doctors by specialty, procedure, service, or equipment to find the best fit for you! 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. Start Here. PO Box 1600 The Act creates specific negotiation and dispute resolution protocols between payer and provider. Provider OnLine Features With UPMC Health Plan's Provider OnLine, you can: 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 a medical emergency, call 911 or go to the nearest emergency department. For Providers About Contact . Not registered with UPMC Health Plan? SIGN Search adult and pediatric providers and schedule appointments online. 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. Find listings of the care providers we partner with including doctors, hospitals, pharmacies . *Disclaimer: This online directory provides a list of UPMC Health Plan providers, and the information contained here is updated periodically. We offer personalized dental care at UPMC Montefiore in Pittsburgh and UPMC Cole in Coudersport and Port Allegany, Pa. Western Pa. // patched for y2k bug! Determine a patient's primary insurance coverage. UPMC for You Dental Advantage Our dental health team at UPMC Cole offers high-quality family dental care at affordable pricing. We also treat serious dental issues to help you keep smiling. 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. For Providers About Contact Search. Providers submitting claims through "January","February","March","April","May","June","July","August","September","October","November","December"); Forgot username or password? The UPMC Presbyterian Dental Center at UPMC Montefiore offers preventive and follow-up dental care. If you are interested in HIPAA-compliant EDI file submission, please refer to the additional set-up documents on this website. Dental Care at UPMC Our dental experts can help you to put your best face forward. 200 Lothrop Street Pittsburgh, PA 15213 412-647-8762 800-533-8762 First-time users can create a Provider OnLine account. // Array of day names For a medical emergency, call 911 or go to the nearest emergency department. Please submit the National Provider Identifier (NPI), along with the tax ID and the provider ID as assigned by UPMC Health Plan. Get the latest resources, news, and announcements from UPMC Health Plan for participating providers. Commercial and Medicare Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. For a medical emergency, call 911 or go to the nearest emergency dept. This person will: If you have not accessed your Provider OnLine account in the past six months, your account may be disabled. Login to Provider Online. Thank you for being a part of the UPMC Dental Advantage/UPMC Vision Advantage network. Federal Employees: Federal Employees Health Benefits Program (FEHB) Dental Advantage Our provider portal is currently unavailable. Receive 24-hour access to claims and coverage information. For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. Claims should be submitted using one of the methods below: Clearinghouse Submission: View members' historical coverage information. As a participating provider, you can access valuable information online by entering your user ID and password in the login box on this page. Find care with UPMC Health Plan's Provider Directory. If you need help with your account, please call 1-866-884-8579. Resources for Dental Providers Vision 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. UPMC Health Plan and SKYGEN Dental Provider Quick Reference Guide.
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