User Login. PO Box 1600 Welcome to MetDental.com. Not registered with UPMC Health Plan? Login/Register. Have a sample 837 file exported from their billing system containing only UPMC Health Plan claims. Dominion National provides dental plans and administrative services to UPMC Health Plan members and maintains an extensive selection of participating dentists. For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. Start Here. Medicare Special Needs Plans: UPMC for Life Complete Care Dental Advantage. I am a: Login. UPMC Health Plan and SKYGEN Clinical Criteria effective 12/18/2022. Browse doctors by specialty, procedure, service, or equipment to find the best fit for you! Use billing software that allows the generation of a HIPAA-compliant 837 professional or institutional file. Login This application is best viewed using Internet Explorer versions 6.0 and higher Login As Provider Network Login Name Password Home Forgot Password? You can request that your account be reactivated by contacting 1-800-937-0438. Federal Employees: Federal Employees Health Benefits Program (FEHB) Dental Advantage Log In to the Dental Advantage Provider Portal Announcements Get the latest updates from UPMC Health Plan. // Array of day names As a network dentist, youll get help with claims status, eligibility, and more. PO Box 1600 Need to schedule by phone? Claim files are transmitted using a secure FTP process that does not require data encryption prior to transmission. Search adult and pediatric providers and schedule appointments online. Learn how to get one now. Submit claim forms to: 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. Forgot username or password? Determine a patient's primary insurance coverage. 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. 200 Lothrop Street Pittsburgh, PA 15213 412-647-8762 800-533-8762 How to Login? If you forgot your User ID or need assistance, please call our Help Desk at 1-800-937-0438. Important: Please provide your National Provider Identifier (NPI) when prompted. First-time users can create a Provider OnLine account. TTY: 711. To learn more, visit healthwise.org. 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. Chat with a UPMC Health Plan provider service representative in real time. For a medical emergency, call 911 or go to the nearest emergency department. Your place to stay in control. Make Provider OnLine security requests to UPMC Health Plan on behalf of other staff members. Our dental health team at UPMC Cole offers high-quality family dental care at affordable pricing. Providers may use the standard PGP encryption process in addition to the secure FTP, if additional data security is desired. 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. Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. The Act creates specific negotiation and dispute resolution protocols between payer and provider. If you are interested in HIPAA-compliant EDI file submission, please refer to the additional set-up documents on this website. Through MetDental, participating Dentists can view rosters, search for Explanation of Payment statements, download Facility Reference Guides, and more. Provider OnLine Features With UPMC Health Plan's Provider OnLine, you can: 205 Millers Run Road, Suite 300, Bridgeville, PA 15017 (Map) 724-934-3334. 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. Sign in to UPMC Cole Connect Patient Portal. Providers submitting claims through 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. 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. Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. Pittsburgh, PA 15213 It is important that you respond to VPoint to ensure your continued relationship with MetLife. Register. Resources for UPMC Health Plan/SKYGEN Dental Providers. 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. Via the Provider OnLine EDI tools, these batches can be viewed in several standard report formats. Your session has ended, thank you for using UPMC Health Plan OnLine. In order to submit EDI files directly to the Health Plan, providers must: UPMC Health Plan currently accepts dual provider identifiers. document.write(dayNames[now.getDay()] + ", " + monthNames[now.getMonth()] + " " + now.getDate() + ", " + year); User name: 2023 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences, Supplemental content provided by Healthwise, Incorporated. Commercial and Medicare For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. Our Dental Benefits Advisory Team is ready to answer your call. // Array of month Names Emdeon should use payer ID 25184. You also can register to join the network. The portal for all UPMC patients EXCEPT those in Central Pa. You also can register to join the network. Search adult and pediatric providers and schedule appointments online. Vision . Browse doctors by specialty, procedure, service, or equipment to find the best fit for you! If you have questions while you are completing the form, contact our Web Support Services at 1-800-937-0438. We offer personalized dental care at UPMC Montefiore in Pittsburgh and UPMC Cole in Coudersport and Port Allegany, Pa. Western Pa. Providers submitting claims through Register. How to Login? For Providers About Contact Search. . View resources for medical providers, log into Provider OnLine, and get access to downloadable forms. Please submit the National Provider Identifier (NPI), along with the tax ID and the provider ID as assigned by UPMC Health Plan. Complete testing and become certified with UPMC Health Plan. Forgot username or password? Get virtual care Schedule a video visit with your regular provider. Sign in/Register I am a:MemberProviderEmployerProducer Sign In Please enter your username. UPMC Vision Advantage Our Provider Partner Update newsletter includes the latest news and information for network providers. Find a UPMC health care facility close to you quickly by browsing by region. The online provider search lets you find a person who provides . Visit our secure website, where network providers can sign in and complete most administrative tasks. Dental . As a participating provider, you can access valuable information online by entering your user ID and password in the login box on this page. Get the latest updates from UPMC Health Plan. For a medical emergency, call 911 or go to the nearest emergency department. Visit UPMC Health Plan's homepage. Forgot UPMC Dental Advantage offers competitive rates, convenient tools, and rapid reimbursement. Announcements Search adult and pediatric providers and schedule appointments online. 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. For Providers About Contact . If you choose this option for claims submission and you do not have a Provider OnLine account, complete this form to sign up. You can follow up with additional questions to the HealthPlanEDI@upmc.edu distribution group. the introduction of UPMC Dental Advantage. These claims are loaded into batches and immediately posted in preparation for adjudication. Get the latest news and information on the EFT/ERA Overview page in the resource center. Need to schedule by phone? To learn how to register, watch our instructional Provider OnLine registration video. For patients of UPMC-affiliated doctors in Central Pa, select UPMC Central Pa Portal. 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. Find care with UPMC Health Plan's Provider Directory. Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. 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. 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. Password: For a medical emergency, call 911 or go to the nearest emergency department. Providers are able to submit claims directly without incurring clearinghouse expenses. For a medical emergency, call 911 or go to the nearest emergency dept. Forgot Manage claimssubmit and manage claims entirely online. To learn how to register, watch our instructional Provider OnLine registration video. When care is coordinated, submit the referring provider NPI if available, as well as the name and UPIN. MetLife is committed to helping our providers have a smooth transition to our new enrollment solution with as little disruption as possible. Dentistry - Find a Doctor | UPMC Need Care? Vision . Our Dental Advantage Newsletter includes the latest news and information for network providers. UPMC Community HealthChoices Dental Allowance Request Form. Online Login: UserID I forgot my user id (Members Only) : There was an error with the Pass through from your Public Website. The portal for UPMC Cole patients receiving inpatient care. for a doctor or specialist. With UPMC Health Plan's Provider OnLine, you can: A provider office should appoint a staff member to serve as Security Officer. var year = now.getFullYear() Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. I am a: Login. Make an appointment Don't have one? Login This application is best viewed using Internet Explorer versions 6.0 and higher Login As Provider Network Login Name Password Home Forgot Password? Need Help? Serve as the provider practices primary contact with UPMC Health Plan regarding Provider OnLine security issues. Interested in joining UPMC Health Plans provider network? We apologize for this inconvenience and look forward to serving you the next time you sign in. It requires the recipient's Practice or Billing System have the ability to automate loading of a file in the mandated format. Home & Community-Based Services . Please sign in to view patient eligibility, The plan is designed to encourage regular preventive care and foster open communication between patients and dentists regarding recommended treatment plans. Interact with the Health Plan on claims issues via a messaging system. This person will: If you have not accessed your Provider OnLine account in the past six months, your account may be disabled. The UPMC Presbyterian Dental Center at UPMC Montefiore offers preventive and follow-up dental care. Patients of UPMC Cole should select the UPMC Cole Connect Patient Portal. View resources for medical providers, log into Provider OnLine, and get access to downloadable forms. Grant access to Provider OnLine to certain staff members on the provider's behalf. Providers. Register. The provider's office can enter claims and verify if they have been accepted and are ready for adjudication. First-time users can create an account by contacting their office Provider OnLine Account Administrator or by calling 1-800-937-0438. Forgot username or password? Phone: 1-800-286-4242. Here you can explore resources and information about Medical Assistance coverage and benefits. 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. Claims should be submitted using one of the methods below: Clearinghouse Submission: If you forgot your user ID or need assistance, please call our Help Desk at 1-800-937-0438. Paper Claim Submission: Submit claim forms to: UPMC Dental Advantage PO Box 1600 Pittsburgh, PA 15230-1600 Pharmacy . For technical questions about the UPMC Central PA Portal, contact the Help Desk Mon. These clearinghouses are then responsible for reformatting these claims to meet HIPAA standards and passing the claims on to the Health Plan. 2599 Wexford Bayne Road, Sewickley, PA 15143 (Map) 724-933-3700. For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. Batch file submissions . Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. Paper Claim Submission: Discover the advantages of joining, and learn about resources available to you as a network provider. Learn about the dental products UPMC Health Plan offers and the variety of resources available to network providers.