For a medical emergency, call 911 or go to the nearest emergency department. Phone: 1-800-286-4242. You also can register to join the network. Get an immediate response if mistakes are made submitting a claim (using HIPAA 837 forms). The plan is designed to encourage regular preventive care and foster open communication between patients and dentists regarding recommended treatment plans. 800-533-8762. Find out how Start Here. For technical questions about the UPMC Central PA Portal, contact the Help Desk Mon. Paper Claim Submission: Submit claim forms to: UPMC Dental Advantage PO Box 1600 Pittsburgh, PA 15230-1600 Our dental experts can help you to put your best face forward. As a participating provider, you can access valuable information online by entering your user ID and password in the login box on this page. View members' historical coverage information. // patched for y2k bug! Please be advised Zelis is the new payment solution for MetLife claim payments. Get virtual care Schedule a video visit with your regular provider. In order to submit EDI files directly to the Health Plan, providers must: UPMC Health Plan currently accepts dual provider identifiers. 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. For patients of UPMC-affiliated doctors in Central Pa, select UPMC Central Pa Portal. Medical . UPMC Dental Advantage offers competitive rates, convenient tools, and rapid reimbursement. Find a Doctor or Provider. Paper Claim Submission:
For a medical emergency, call 911 or go to the nearest emergency department. 2022 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences. Not a UPMC Central PA Portal Patient? 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. Our Provider Partner Update newsletter includes the latest news and information for network providers. Browse doctors by specialty, procedure, service, or equipment to find the best fit for you! Password: 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. First-time users can create an account by contacting their office Provider OnLine Account Administrator or by calling 1-800-937-0438. 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. through Fri., 8 a.m. to 5 p.m. at 1-888-782-5678 or 717-988-0000 press 6 View resources for medical providers, log into Provider OnLine, and get access to downloadable forms. Important: Please provide your National Provider Identifier (NPI) when prompted. We offer personalized dental care at UPMC Montefiore in Pittsburgh and UPMC Cole in Coudersport and Port Allegany, Pa. Video Visit. Find a UPMC health care facility close to you quickly by browsing by region. You can request that your account be reactivated by contacting 1-800-937-0438. Access your UPMC information in MyUPMC. Your Username or Password? Read Dental Announcements The online provider search lets you find a person who provides . About the Electronic Remittance Advice
Vision . Browse doctors by specialty, procedure, service, or equipment to find the best fit for you! Dental . Dental . var now = new Date(); As a network provider, you can: Verify eligibilitycheck plan status with a member's ID, full name, and date of birth. document.write(dayNames[now.getDay()] + ", " + monthNames[now.getMonth()] + " " + now.getDate() + ", " + year); User name: Pittsburgh, PA 15230-1600, Join our UPMC Dental Advantage Provider Network, ONC 21st Century Cures Act Member Resource Center. TTY: 711. 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. For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. This person will: If you have not accessed your Provider OnLine account in the past six months, your account may be disabled. UPMC Health Plan accepts electronic claims in data file transmissions. Providers submitting claims through
Search adult and pediatric providers and schedule appointments online. Visit UPMC Health Plan's homepage. UPMC Vision Advantage
Need to schedule by phone? PO Box 1600
Learn about and take advantage of the resources available to you as a network provider. UPMC CCP-South Fayette. First-time users can create a Provider OnLine account. 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? "January","February","March","April","May","June","July","August","September","October","November","December"); UPMC Dental Advantage Provider Portal Visit our secure website, where network providers can sign in and complete most administrative tasks. Member Login. Use billing software that allows the generation of a HIPAA-compliant 837 professional or institutional file. UPMC Health Plan and SKYGEN Clinical Criteria effective 12/18/2022. 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. Children's Health Insurance Program: UPMC for Kids (CHIP) Dental Advantage
UPMC Dental Advantage offers UPMC employees two options Standard and Premium with a network of fully credentialed dentists. Login/Register. Our Dental Advantage Newsletter includes the latest news and information for network providers. Learn about the dental products UPMC Health Plan offers and the variety of resources available to network providers. First-time users can create an account by contacting their office Provider OnLine Account Administrator or by calling 1-800-937-0438. Login/Register.
Browse doctors by specialty, procedure, service, or equipment to find the best fit for you! Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. Submission of dental claims and prior authorizations, Member status and eligibility determination. Emdeon should use payer ID 23281. Your Username or Password? Forgot username or password? Manage claimssubmit and manage claims entirely online. Account Login | MyUPMC Log In To Your Account Username Password Sign Up Forgot Username? Dental . For Providers About Contact . 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. As a provider-led health insurer, we have a unique appreciation for our relationships with network doctors and care providers. Search adult and pediatric providers and schedule appointments online. The portal for all UPMC patients EXCEPT those in Central Pa. Electronically filed claims may be submitted in the following ways: Individual claim entry
Have a sample 837 file exported from their billing system containing only UPMC Health Plan claims. 205 Millers Run Road, Suite 300, Bridgeville, PA 15017 (Map) 724-934-3334. Login This application is best viewed using Internet Explorer versions 6.0 and higher Login As Provider Network Login Name Password Home Forgot Password? . Log In to the Dental Advantage Provider Portal Announcements Get the latest updates from UPMC Health Plan. Find listings of the care providers we partner with including doctors, hospitals, pharmacies . Need to schedule by phone? 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. 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. Forgot username or password? Forgot Password? Learn more about our plans and programs, find a dentist, or sign in to view patient eligibility, plan detail, and claims. Register. Get the latest updates from UPMC Health Plan. Sign in/Register I am a:MemberProviderEmployerProducer Sign In Please enter your username. Login/Register. Make Provider OnLine security requests to UPMC Health Plan on behalf of other staff members. If you choose this option for claims submission and you do not have a Provider OnLine account, complete this form to sign up. So many helpful features. Need to schedule by phone? 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. Get the latest news and information on the EFT/ERA Overview page in the resource center. For general assistance or inquiries regarding web portals or logins, please contact us here. Paper Claim Submission:
Patients of UPMC Cole should select the UPMC Cole Connect Patient Portal. Forgot username or password? If you can't log in, contact Sales Support at 1-855-862-6515. 1 Childrens Hospital Drive, 4401 Penn Avenue, Floor 7, Pittsburgh, PA 15224 (Map) Children's North Ambulatory Surgery Center. . 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. Announcements Need to schedule by phone? Providers may use the standard PGP encryption process in addition to the secure FTP, if additional data security is desired. Find care with UPMC Health Plan's Provider Directory. Make an appointment You can follow up with additional questions to the HealthPlanEDI@upmc.edu distribution group. Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. . To learn how to register, watch our instructional Provider OnLine registration video. Our Dental Benefits Advisory Team is ready to answer your call. 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. Need Help? For a medical emergency, call 911 or go to the nearest emergency dept. Claim files are transmitted using a secure FTP process that does not require data encryption prior to transmission. We use the latest oral health technology and tools so you can feel good about flashing those pearly whites. *Disclaimer: This online directory provides a list of UPMC Health Plan providers, and the information contained here is updated periodically. Need to schedule by phone? How to Login? For member identification, submit the member's 11-digit ID number or the government-assigned identifiers for Medicare or Medical Assistance members. Dentistry - Find a Doctor | UPMC Need Care? Receive 24-hour access to claims and coverage information. DHMO providers will have the ability to manage all payments under one experience on the Zelis platform in future phases. Find out how to apply for the Preferred Dentist Program 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. Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. If you have questions while you are completing the form, contact our Web Support Services at 1-800-937-0438.