Resources for Dental Providers

Already with us? You can:

• Review UPMC Dental Advantage communications:
  • COVID-19 Dental Advantage Communication – July 1, 2020
    
  • On March 15, 2021, the American Dental Association entered new dental procedure codes to document the delivery of COVID-19 vaccinations upon FDA approval and as permitted under state laws governing scope of practice. Each vaccine has a unique code for administration, and allowable codes will be updated as this information is released or updated by the American Medical Association, Centers for Medicare and Medicaid Services, and Pennsylvania Department of Human Services.
    
    UPMC Health Plan is requesting that claims be submitted via the CMS 1500 Form to the medical claim reimbursement address below. Complete the health insurance claim form.
    
    Note: All Medicare vaccine claims should be billed to Original Medicare (FFS) through 2021.
    
    Claim forms can be sent to the addresses noted per specific line of business.
    
    UPMC Community HealthChoices (Medical Assistance)
    
    UPMC Community HealthChoices
    PO Box 106042
    Pittsburgh, PA 15230-2995
    
    UPMC for Kids (CHIP)
    
    UPMC for Kids
    PO Box 2999
    Pittsburgh, PA 15230-2999
    
    UPMC for You (Medical Assistance)
    
    UPMC for You
    PO Box 2995
    Pittsburgh, PA 15230-2995
    
    UPMC Health Plan (Commercial)
    
    UPMC Health Plan
    PO Box 2999
    Pittsburgh, PA 15230-2999
    
    

    Dental Procedure Code:	Description:
    D1701	Pfizer Vaccine Admin Dose 1
    D1702	Pfizer Vaccine Admin Dose 2
    D1703	Moderna Vaccine Admin Dose 1
    D1704	Moderna Vaccine Admin Dose 2
    D1705	AstraZeneca Vaccine Admin Dose 1
    D1706	AstraZeneca Vaccine Admin Dose 2
    D1707	Janssen Vaccine Admin Single Dose

    While use of the CMS 1500 form is encouraged, in the event a claim is submitted on an ADA dental claim form, the claim will be processed through the member’s UPMC Health Plan medical coverage.
    
    UPMC Health Plan does not practice medicine or exercise control over the methods or professional judgments by which providers render medical services to members. Nothing in these materials should be construed to supersede or replace the clinical judgment of a provider.
    
    Providers are responsible for appropriate billing of services. These suggested codes are not meant to provide or supersede clinical judgment.
• Sign in to your secure UPMC Dental Advantage Provider Portal account.
• Update your contact or profile information. Log in above to complete.
• UPMC Dental Advantage Provider Manuals
• UPMC Dental Advantage – Product Guide
• UPMC Dental Advantage Plan Updates for 2021
• Download a form for your practice:
  • Authorization for Electronic Reimbursement by UPMC Insurance Services Division on Behalf of UPMC Dental Advantage
  • Authorization for Change/Termination of Electronic Funds Transfer by UPMC Insurance Services Division
  • CDT Procedure and Benefit Code Changes
  • Dental Claim Form
  • Out-of-Area Dental Claim Form
  • Self-Audit Overpayment Form
• Submit information for Disclosure of Ownership and Control.
• Report fraud and abuse to UPMC Dental Advantage. Here are some examples of fraud and abuse:
  • Billing for services that were never provided to the member
  • Billing more than once for the same service
  • Falsifying records
  • Performing and/or billing for inappropriate or unnecessary services

How to report it:

• Call our dedicated hotline at 1-866-FRAUD-01 (1-866-372-8301). Voicemail is available at all times. You may remain anonymous. TTY users should call 711.
• Email specialinvestigationsunit@upmc.edu.
• Send information by U.S. mail:

  UPMC Dental Advantage

  Special Investigations Unit
  PO Box 2968
  Pittsburgh, PA 15230
  

  Be sure to mark the outside of the envelope "confidential" or "personal." You may remain anonymous.

Check our FAQ or contact us with any questions.