The UPMC Health Plan Provider OnLine portal represents a critical digital platform designed to streamline healthcare provider interactions, offering comprehensive digital access to essential patient and claims information. As the only provider-led health insurer in western Pennsylvania, UPMC Health Plan emphasizes robust digital support for healthcare professionals.
Official Links
What Providers Can Do
Healthcare providers utilizing the UPMC Health Plan Provider OnLine portal can:
- View real-time patient and claims data
- Access up-to-date eligibility information
- Check primary care physician (PCP) details
- Review members’ historical coverage information
- Interact with the Health Plan regarding claims issues
- Determine patient’s primary insurance coverage
- Receive immediate feedback on claim submissions
Access and Registration
Who Can Use the Portal
- Participating healthcare providers
- Authorized medical practice staff members
- Designated Provider OnLine Account Administrators
Registration Process
Providers can register by:
- Contacting their office Provider OnLine Account Administrator
- Calling 1-800-937-0438 for assistance
Note: A provider office must appoint a staff member as a Security Officer responsible for managing portal access.
Electronic Transaction Capabilities
Claims Submission Methods
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Individual Claim Entry
- Direct submission via secure internet interface
- Compatible with professional (HCFA/CMS-1500) and institutional (UB-92) claims
-
Batch File Submissions
- Electronic claims transmission through secure FTP
- Compatible with clearinghouses like WebMD
Electronic Remittance Advice (835)
- HIPAA-compliant electronic payment notifications
- Automated file loading capabilities
- Direct download options available
Security and Compliance
Key Security Features
- HIPAA-compliant transactions
- Secure internet encryption
- 24-hour access with controlled user permissions
- Real-time chat with provider service representatives
Account Management
- Accounts inactive for six months may be disabled
- Reactivation available by contacting web support
Technical Requirements
To submit electronic files directly, providers must:
- Use HIPAA-compliant billing software
- Have internet access
- Install secure FTP add-ons
- Complete certification with UPMC Health Plan
Support and Assistance
Contact Information
- Web Support: 1-800-937-0438
- EDI Inquiries: [email protected]
Unprovided Information
The following details were not explicitly available in the source documents:
- Specific mobile app download instructions
- Detailed pricing for portal services
- Comprehensive training resources
The UPMC Health Plan Provider OnLine portal offers a comprehensive, secure digital platform enabling healthcare providers to efficiently manage patient information, claims, and interactions with minimal administrative overhead.
Disclaimer: Information current as of August 2025, based on UPMC Health Plan documentation.
https://upmchealthplan.com/en/providers/online
With UPMC Health Plan’s Provider OnLine, you can: View up-to-date eligibility, PCP information, and covered benefits. View real-time patient and claims data.
https://upmchealthplan.com/en/providers
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