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Welcome and Key Contacts – Chapter AWelcome and Key ContactsA.1Table of ContentsA.2WelcomeA.3UPMC Health Plan WebsiteA.4Provider OnLineA.6How to Use This ManualA.7Key ContactsA.8Table A1 – UPMC Behavioral Health Services (BHS)A.10Table A2 – UPMC Community HealthChoices (CHC)A.15Table A3 – UPMC for Kids (CHIP)A.17Table A4 – UPMC for Life (Medicare)A.19Table A5 – UPMC for You (Medical Assistance)A.24Table A6 – UPMC Health Plan (Commercial)A.26 Table A7 – UPMC for Life Complete Care (HMO SNP)A.28 Table A8 – Other Program and Government ContactsUPMC Health Planupmchealthplan.com 2021, effective 4-1-21. All rights reserved.1
Welcome and Key Contacts – Chapter AWelcomeWelcome to UPMC Health Plan, a provider-led health plan committed to quality coverage for itsmembers and employer clients.Guided by the principle of treating others as we want to be treated, UPMC Health Plan’s goal isto be the nation’s best service-centered health benefits company, providing the highest qualityproducts at an affordable price to families, individuals, and employers.We pledge to satisfy customers, grow membership, control expenses, and improve the health ofpeople living in the communities we serve.UPMC Health Plan was founded as a provider-led managed care organization. As such, UPMCHealth Plan has never placed barriers between doctor and patient. We consider the providers inour network to be leaders in the quality of care they provide. Our goal as a health insurer is towork with our providers to make sure our members get regular preventive care and qualitymedical care, as well as to reduce unnecessary medical procedures.To that end, this document is intended to serve as the main resource for information aboutUPMC Health Plan’s products, services, and claims processes, and as a reference for providerswhen questions arise. If certain situations require further explanation, providers should callProvider Services from 8 a.m. to 5 p.m., Monday through Friday, at the following numbers:UPMC Community HealthChoices (Medical Assistance)UPMC Behavioral Health Services (BHS)UPMC for Kids (CHIP)UPMC for Life (Medicare)UPMC for Life Complete Care (HMO SNP)UPMC for You (Medical Assistance)UPMC Health Plan 6-918-1595Other help, including provider network directories, is also available online atupmchealthplan.com.UPMC Health Plan 2021, effective 4-1-21. All rights reserved.upmchealthplan.com2
Welcome and Key Contacts – Chapter AUPMC Health Plan WebsiteUPMC Health Plan’s website is located at upmchealthplan.com.Physicians and other providers can find the following information on UPMC Health Plan’swebsite: Clinical practice guidelines Member benefit plans News and announcements Policies Provider directory (hard copy or CD available upon request) Provider information (links to various other UPMC Health Plan documents forproviders) Provider manual (hard copy or CD available upon request) Provider news (via the Physician Partner Update (PPU)) UPMC Health Plan annual report Wellness informationUPMC Health Plan 2021, effective 4-1-21. All rights reserved.upmchealthplan.com3
Welcome and Key Contacts – Chapter AProvider OnLineProvider OnLine (POL), is a self-serve website that is available 24 hours a day, 7 days aweek and can significantly reduce the number of telephone calls a network provider needs tomake to UPMC Health Plan, thereby reducing the time it takes to perform their daily tasks.This secure online service, available from any computer with internet access allows providersto perform a wide variety of administrative functions, including submitting a priorauthorization request, checking on the status of an authorization request, checking membereligibility and covered benefits, submitting claims for reimbursement, checking on the statusof a claim, viewing an Explanation of Payment (EOP), sending and receiving messages orchatting with a Provider Services representative in real time. POL is utilized to relay generalcommunications to Providers; Providers should frequently check POL for updates. In addition,POL allows the Provider to complete an authorization to receive electronic payments byElectronic Funds Transfer (EFT). EFT Transfer will allow the Provider’s office or practice toreceive reimbursement from UPMC Health Plan sooner than paper checks. NOTE: All contracted Providers are required to complete the Authorizationfor Electronic Reimbursement form by going toupmchealthplan.com/providers/online and selecting EFT Transfer Form.Providers can also request Electronic Remittance Advice (ERA) throughProvider OnLine. NOTE: Per HIPAA the only permissible format for an electronic remittance advice,in a data file, is the ANSI ASC X12.835, Health Care Claim Payment/Advice.This file is commonly referred to as an 835.It requires the recipient's practice or billing system have the ability to automateloading a file in the mandated format. NOTE: All contracted providers should utilize POL to review their current and historicalEOPs and print a paper copy of the EOP. Providers with POL access and thosewho elect to utilize ERA will not receive a paper EOP. Paper EOPs will only besent upon specific request. POL is available 24 hours a day, 7 days a week.UPMC Health Plan 2021, effective 4-1-21. All rights reserved.upmchealthplan.com4
Welcome and Key Contacts – Chapter AThe eligibility section of POL shows the member’s specific schedule of benefits, including riders(additional benefits beyond basic coverage), and the date such benefits became effective. Thissection also shows up to date coordination of benefit (COB) information and current out ofpocket costs (copays, deductible, etc.) that have been incurred. To view information about aneligible member the provider needs one of the following: Member’s first and last name Member’s identification numberProvider OnLine can be accessed from upmchealthplan.com/providers. Enter your user IDin the provider login box. If you do not have a Provider OnLine account, your practice OnLineAccount Administrator will help you gain this access. NOTE: The OnLine Account Administrator (OAA) is the individual within apractice who manages all Provider OnLine security and access.If you do not have an OAA, complete the first-time user registration urityRequest.aspx.To submit a prior authorization request, log into Provider Online at:upmchealthplan.com/providers. Select the Auth Entry/Inquiry option from the main menuand follow the prompts.If a provider forgot their UPMC Health Plan Provider OnLine User ID or needs assistanceregistering as a first-time user, call the Help Desk at 1-800-937-0438. Contact the provider’sphysician account executive or call Provider Services at 1-866-918-1595 with any questions.Providers who need to request authorization to prescribe a medication that may have a quantitylimit, require prior authorization, or for non-formulary medications should submit the requestonline at upmc.promptpa.com or visit upmchealthplan.com to obtain a prior authorizationform and submit it by fax to 412-454-7722. See Obtaining Prior Authorization, Pharmacy Services, Chapter J.UPMC Community HealthChoices Home and Community Based Services providers canaccess Provider OnLine to check member eligibility and benefits but claims submissionwill occur in HHAeXchange. For more information see Provider OnLine, Claims Procedures, Chapter H.UPMC Health Plan 2021, effective 4-1-21. All rights reserved.upmchealthplan.com5
Welcome and Key Contacts – Chapter AHow to Use This ManualThis manual provides physicians, hospitals, long-term service and support providers, andother health care practitioners/providers in the UPMC Health Plan* network with a succinct,easy-to-use guide to UPMC Health Plan’s business and medical management practices. Thismanual directs users to important information through text “callouts.”Samples of the callouts include:Key PointsKey Points are major highlights about a particular topic. These points are listed in bulletform for easy readability.AlertAn Alert draws attention to critical information.Closer Look at (Subject)A Closer Look provides additional information about a topic, such as animportant phone number, address, or useful fact.This chapter includes a list of key contacts. Throughout this manual there are important phonenumbers and addresses, all of which are printed in bold-face type.This manual contains a dual-definition glossary. All terms include a common languagedefinition, and some may include a regulatory definition. Regulatory definitions are requiredby regulatory and other government agencies and are standard to the insurance industry,including UPMC Health Plan. See Glossary and Abbreviations, Chapter K.UPMC Health Plan will update this manual and post revisions as needed. The bottom of eachpage indicates the copyright date and the edition to indicate the timeliness of the information.Closer Look at UPMC Health Plan**The term UPMC Health Plan collectively refers to UPMC Health Plan Inc.,UPMC Health Benefits Inc., UPMC Benefit Management Services Inc.,UPMC Health Network Inc., UPMC Health Options Inc., UPMC HealthCoverage Inc., and UPMC for You Inc.UPMC Health Plan 2021, effective 4-1-21. All rights reserved.upmchealthplan.com6
Welcome and Key Contacts – Chapter AKey ContactsThe following tables include all the important telephone and fax numbers listed in the UPMCHealth Plan Provider Manual.Before calling Provider Services, please have the following information available: Provider’s tax identification (ID) number (preferred) or UPMC Health Planprovider number The member’s identification number The phone number of the telephone from which the call is madeTable A1 – UPMC Behavioral Health Services (BHS)Table A2 – UPMC Community HealthChoices (CHC)Table A3 – UPMC for Kids (CHIP)Table A4 – UPMC for Life (Medicare)Table A5 – UPMC for You (Medical Assistance)Table A6 – UPMC Health Plan (Commercial)Table A7 – UPMC for Life Complete Care (HMO SNP)Table A8 – Other Program and Government ContactsUPMC Health Plan 2021, effective 4-1-21. All rights reserved.upmchealthplan.com7
Welcome and Key Contacts – Chapter AUPMC Behavioral Health Services (BHS)Table A1: UPMC Behavioral Health Services (UPMC BHS) ContactsContactTelephone NumberFraud and Abuse Hotline Number(For UPMC Health Plan)UPMC Behavioral HealthServices Health Care Conciergeteam1-866-372-8301Behavioral Health CaseManagement Programs1-888-777-8754Behavioral Health UPMC forKids (CHIP)1-800-650-87621-888-251-0083TTY: 1-877-877-3580All UPMC BHS Health Care Concierge lines answer24 hours a day, seven days a week, 365 days a year.Routine questions are best answered by calling duringbusiness hours: Monday through Friday, 8 a.m. to 5 p.m.Provider Contracting andCredentialingCommunity Care Behavioral Health Organization(CCBHO)339 Sixth AvenueSuite 1300Pittsburgh, PA 15222ccbh.comProvider Fax Line(Authorization FormsOther Clinical Information)Fax: 1-888-249-5646Provider Voice Line1-866-441-418524 hours a day, 7 days a week, 365 days a yearUPMC Behavioral HealthServices Corporate OfficesUPMC Health PlanU.S. Steel Tower600 Grant StreetPittsburgh, PA 15219UPMC Health Plan ClaimsDepartment1-888-876-2756UPMC Health Plan 2021, effective 4-1-21. All rights reserved.upmchealthplan.com8
Welcome and Key Contacts – Chapter ATable A1: UPMC Behavioral Health Services (BHS) Contacts, (continued)ContactTelephone NumberProvider reference materialsBehavioral health provideralerts, newsletter articles, andformsupmchealthplan.com/providers/patient index.htmlThe Mental Health MedicalNecessity Criteria Set(Utilized by UPMC HealthPlan BHS) The Mihalik’s MedicalNecessity Criteria,Version 8.7.0, Year2020.themihalikgroup.comFor password assistance: 1-773-929-1722 The ChemicalDependency MedicalNecessity Criteria SetsAmerican Society for Addiction Medicine (ASAM),Year 2013.Publications Distribution CenterPO Box 101Annapolis Junction, MD 20701-01011-800-844-8948asam.org(For Adolescents ,Adults,and Children)Additional sources to obtain acopy of the Medical NecessityCriteria.UPMC Behavioral HealthServices1-866-441-4185Representatives are available 24 hours a day, 7 days aweek, 365 days a year.UPMC Health Plan 2021, effective 4-1-21. All rights reserved.upmchealthplan.com9
Welcome and Key Contacts – Chapter AUPMC Community HealthChoices (CHC)Table A2: UPMC Community HealthChoices ContactsContactTelephone NumberBehavioral Health Services – Managed Care Organizations (BH-MCO)Each HealthChoices consumer is assigned a Behavioral Health Managed Care Organization(BH-MCO) based on his or her county of residence.Community BehavioralPhiladelphiaHealth (CBH)(See CBH’s website for a listing of member and provider phone801 Market Streetnumbers.)Suite 7000Philadelphia, PA 19107cbhphilly.org/Community CareBehavioral HealthOrganization (CCBHO)339 Sixth AvenueSuite 1300Pittsburgh, PA 15222Magellan BehavioralHealth of Pennsylvania(MBH)One Bethlehem Plaza17 West Broad St.Suite 210Bethlehem, PA 18018Adams, Allegheny, Bedford, Berks, Blair, Bradford, Cameron,Carbon, Centre, Chester, Clarion, Clearfield, Clinton,Columbia, Elk, Erie, Forest, Huntingdon, Jefferson, Juniata,Lackawanna, Luzerne, Lycoming, McKean, Mifflin, Montour,Monroe, Northumberland, Pike, Potter, Schuylkill, Snyder,Somerset, Sullivan, Susquehanna, Tioga, Union, Warren,Wayne, Wyoming and York counties.(See CCBH’s website for a listing of member and providerphone numbers.)ccbh.comBucks, Cambria, Delaware, Lehigh, Montgomery andNorthampton counties(See Magellan’s website for a listing of member and providerphone numbers.)magellanofpa.comPerformCare8040 Carlson RoadHarrisburg, PA 17112Cumberland, Dauphin, Franklin, Fulton, Lancaster, Lebanon,and Perry countiesValue Behavioral Healthof Pennsylvania (VBH)520 Pleasant Valley RoadTrafford, PA 15085Armstrong, Beaver, Butler, Crawford, Fayette, Greene, Indiana,Lawrence, Mercer, Venango, Washington, and Westmorelandcounties(See PerformCare’s website for a listing of member and providerphone numbers.)pa.performcare.org(See VBH’s website for a listing of member and provider phonenumbers.)vbh-pa.comUPMC Health Plan 2021, effective 4-1-21. All rights reserved.upmchealthplan.com10
Welcome and Key Contacts – Chapter ATable A2: UPMC Community HealthChoices Contacts (continued)ContactPhone NumberCommunity HealthChoices HotlinePA Enrollment Support1-844-824-3655TTY: 1-833-254-0690Dental – SKYGEN USAskygenusa.comProvider Call UPMC Community HealthChoicesHealth Care Concierge team1-844-833-0523TTY: 711DHS Adult Protective Services andOlder Adult Protective ServicesStatewide Hotline: 1-800-490-8505Disability Rights Pennsylvania412-391-5225 (Pittsburgh Office)215-238-8070 (Philadelphia Office)717-236-8110 (Harrisburg Office)Medical Assistance TransportationProgram(Provides transportation to medicalappointments)The member’s county of residence arranges thetransportation.(See MATP website for phone number of the localMATP provider.)matp.pa.gov/CountyContact.aspxOffice of Medical Assistance(OMAP) MA Provider ComplianceHotline1-866-379-8477Fax: 717-772-4655TTY: 1-866-379-8477Pennsylvania Department of HumanServices (DHS)General InformationProvider HotlineElectronic Verification armacy Services1-800-396-4139Fax: 412-454-7722UPMC Health Plan 2021, effective 4-1-21. All rights reserved.upmchealthplan.com11
Welcome and Key Contacts – Chapter ATable A2: UPMC Community HealthChoices Contacts (continued)ContactTelephone NumberProvider Network Management(For notifying UPMC Health Plan ofprovider practice changes; to be usedby all provider types)Fax: 412-454-8225Provider Services1-844-860-9303Hours: Monday through Friday, 8 a.m. to 5 p.m.Renal CareESRD Care Managers1-866-778-6073Transportation ServicesUPMC Medical Transportation1-877-521-RIDE (7433)UPMC Community HealthChoicesFraud, Waste and AbuseUPMC Community HealthChoicesHealth Care Concierge team1-844-881-4143UPMC Community HealthChoicesService Coordination DepartmentSouthwest PA: 1-844-860-9302 or 1-844-881-4149Southeast PA: 1-833-672-8078Remainder of PA: 1-833-280-8508Hours: Monday through Friday: 8 a.m. to 5 p.m.UPMC Community HealthChoicesWebsiteupmchealthplan.com/chcUPMC Disabilities Resource Center412-605-1483TTY: 711disabilitiesresource@upmc.eduUPMC Health Plan Web Services(Web support)1-800-937-0438HPOnline@upmc.eduUPMC Health Plan Websiteupmchealthplan.comUtilization Management(Includes prior authorization andconcurrent change.html1-844-833-0523TTY: 711Hours:Monday through Friday, 8 a.m. to 4:30 p.m.Vision – EnvolveMember Services1-866-838-7612Provider Services1-866-838-7612TTY: 711UPMC Health Plan 2021, effective 4-1-21. All rights reserved.upmchealthplan.com12
Welcome and Key Contacts – Chapter ACloser Look at Community HealthChoicesCommunity HealthChoices is Pennsylvania’s mandatory managed care programfor individuals who are eligible for both Medical Assistance and Medicare(dual eligible), older adults, and individuals with physical disabilities – servingmore people in communities while giving them the opportunity to work, spendmore time with their families and experience an overall better quality of life.The CHC population consists of two groups: Dual Eligible Participants:o Individuals enrolled in both Medicare and Medical Assistance. Participants needing LTSS Services:o Individuals who qualify for Medical Assistance long-termservices and supports (LTSS) due to a need for the level ofcare provided by a nursing facility.o Participants receive LTSS at home through a waiver program or residein a nursing facility.o They may also be enrolled in both Medicare and Medical Assistance.Participants have access to medical care and other appropriate physical health services,whether the services are delivered on an inpatient or outpatient basis, through aCommunity HealthChoices Managed Care Organization (CHC-MCO). Participantsevaluated to need nursing facility level of care also have access to Long-Term Servicesand Supports (LTSS).Participants receive mental health and/or drug and alcohol services through BehavioralHealth Managed Care Organizations. This component is overseen by the Department ofHuman Services’ Office of Mental Health and Substance Abuse Services. CHC-MCOsassist participants to access these services.UPMC Health Plan 2021, effective 4-1-21. All rights reserved.upmchealthplan.com13
Welcome and Key Contacts – Chapter ACloser Look at Community HealthChoicesUPMC Community HealthChoices is one of the Managed CareOrganizations offered to recipients in the following zonesSouthwest ZoneEffective 1/1/18Allegheny, Armstrong, Beaver, Bedford,Blair, Butler, Cambria, Fayette, Greene,Indiana, Lawrence, Somerset,Washington, and Westmoreland countiesSoutheast ZoneEffective 1/1/19Bucks, Chester, Delaware, Montgomeryand Philadelphia countiesRemainder ofPennsylvaniaEffective 1/1/20Adams, Berks, Bradford, Cumberland,Dauphin, Franklin, Fulton, Huntingdon,Lancaster, Lebanon, Lehigh,Northampton, Perry, York, Cameron,Carbon, Centre, Clarion, Clearfield,Crawford, Columbia, Crawford, Elk,Erie, Forest, Jefferson, Juniata,Lackawanna, Luzerne, Lycoming,McKean, Mercer, Mifflin, Monroe,Montour, Northumberland, Pike, Potter,Schuylkill, Snyder, Sullivan,Susquehanna, Tioga, Union, Venango,Wayne, Wyoming and Warren countiesUPMC Health Plan 2021, effective 4-1-21. All rights reserved.upmchealthplan.com14
Welcome and Key Contacts – Chapter AUPMC for Kids (CHIP)Table A3: UPMC for Kids (CHIP) ContactsContactTelephone NumberBehavioral Health ServicesUPMC Behavioral HealthServices (BHS)Provider Services1-866-441-4185UPMC Behavioral HealthServices Concierge team1-800-650-8762TTY: 711Dental – SKYGEN USAskygenusa.comProvider Call UPMC for Kids Health CareConcierge team1-800-650-8762TTY:711Fraud and Abuse Hotline(For UPMC Health Plan)1-866-372-8301TTY: 711Health Management & Case1-866-778-6073ManagementFax: 412-454-7552(Specialized programs to improvethe health of members)Laboratory ServicesAssociated Clinical Laboratories(Northern Pennsylvania)1-800-937-8028Quest Diagnostics, Inc.(Southern Pennsylvania)1-800-920-9220Maternity ProgramUPMC Health Plan maternityprogram1-866-463-1462Fax: 412-454-8558UPMC Health Plan 2021, effective 4-1-21. All rights reserved.upmchealthplan.com15
Welcome and Key Contacts – Chapter ATable A3: UPMC for Kids (CHIP) Contacts (continued)ContactTelephone NumberPharmacy Services1-800-979-8762Fax: 412-454-7722Express Scripts(Mail-order)1-877-787-6279Fax: 1-800-636-9494TTY: 1-800-899-2114Accredo Pharmacy(Mail-order – for specialtymedications only)1-888-853-5525Provider Network Management(For notifying UPMC HealthPlan of provider practicechanges.)Fax: 412-454-8225Provider Services1-800-650-87621-866-918-1595Hours: Monday through Friday, 8 a.m. to 5 p.m.UPMC for Kids Health CareConcierge team1-800-650-8762TTY: 711upmchealthplan.com/providers/change.htmlUPMC Health Plan Web Services 1-800-937-0438(Web support)HPOnline@upmc.eduUPMC Health Plan Websiteupmchealthplan.comUPMC Medical Transport1-877-521-RIDE (7433)Utilization Management(Includes prior authorization andconcurrent review.)1-800-425-7800Hours: Monday through Friday, 8 a.m. to 4:30 p.m.Vision – EnvolveMember ServicesProvider Services1-866-921-79651-866-921-7965TTY: 711UPMC Health Plan 2021, effective 4-1-21. All rights reserved.upmchealthplan.com16
Welcome and Key Contacts – Chapter AUPMC for Life (Medicare)Table A4: UPMC for Life (Medicare) ContactsContactTelephone NumberAssist America1-800-872-1414 (within U.S.)1-301-656-4152 (outside U.S.)1-609-986-1234 (within U.S.)Behavioral Health ServicesUPMC Behavioral Health Services(BHS)Provider ServicesHealth Care Concierge team1-866-441-41851-888-251-0083TTY: 1-877-877-3580Case Management1-866-778-6073Fax: 412-454-7552Dental – SKYGEN USA(Select employee group plans ONLY)skygenusa.comProvider Call UPMC for Life Health Care Conciergeteam1-855-306-8277TTY:711Fraud and Abuse Hotline(For UPMC Health Plan)1-866-372-8301TTY: 711Health Management & CaseManagement(Specialized programs to improve thehealth of members.)1-866-778-6073Fax: 412-454-7551Maternity ProgramUPMC Health Plan Care ManagementMedicare Hotline(General services)1-866-778-6073Fax: 412-454-85581-800-MEDICARE (633-4227)UPMC Health Plan 2021, effective 4-1-21. All rights reserved.upmchealthplan.com17
Welcome and Key Contacts – Chapter ATable A4: UPMC for Life (Medicare) Contacts (continued)ContactTelephone NumberPharmacy Services1-800-979-8762Fax: 412-454-7722Express Scripts(Mail order)1-877-787-6279Fax: 1-800-636-9494TTY: 1-800-899-2114Accredo Pharmacy(Mail order – for specialtymedications only.)1-866-848-9870Fax: 1-888-773-7386TTY: 1-800-955-8770Provider Network Management(For notifying UPMC HealthPlan of provider practicechanges.)Fax: mlProvider Services1-877-539-30801-866-918-1595Hours: Monday through Friday, 8 a.m. to 5 p.m.Renal CareESRD Care Managers1-866-778-6073UPMC for Life HealthcareConcierge team1-877-539-3080TTY: 711UPMC Health Plan Web Services 1-800-937-0438(Web support)HPOnline@upmc.eduUPMC Health Plan Websiteupmchealthplan.comUPMC Medical Transport1-877-521-RIDE (7433)Utilization Management(Includes prior authorization andconcurrent review.)1-800-425-7800Hours: Monday through Friday, 8 a.m. to 4:30 p.m.Vision – UPMC Vision CareMember ServicesProvider Services1-877-539-30801-877-262-7870TTY: 711UPMC Health Plan 2021, effective 4-1-21. All rights reserved.upmchealthplan.com18
Welcome and Key Contacts – Chapter AUPMC for You (Medical Assistance)Table A5: UPMC for You (Medical Assistance) ContactsContactTelephone NumberBehavioral Health Services – Managed Care Organizations (BH-MCO)Each HealthChoices consumer is assigned a Behavioral Health Managed Care Organization(BH-MCO) based on his or her county of residence.Philadelphia countyCommunity BehavioralHealth (CBH)See CBH’s website for a listing of member and provider phone801 Market Streetnumbers: cbhphilly.org/Philadelphia, PA 19107Community CareBehavioral HealthOrganization (CCBHO)339 Sixth AvenueSuite 1300Pittsburgh, PA 15222Adams, Allegheny, Bedford, Berks, Blair, Bradford, Cameron,Carbon, Centre, Chester, Clarion, Clearfield, Clinton, Columbia,Elk, Erie, Forest, Huntingdon, Jefferson, Juniata, Lackawanna,Luzerne, Lycoming, McKean, Mifflin, Monroe, Montour,Northumberland, Pike, Potter, Schuylkill, Snyder, Somerset,Sullivan, Susquehanna, Tioga, Union, Warren, Wayne, Wyoming,and York countiesSee CCBH’s website for a listing of member and provider phonenumbers: ccbh.comMagellan BehavioralHealth of Pennsylvania(MBH)Bucks, Cambria, Delaware, Lehigh, Montgomery, andNorthampton countiesOne Bethlehem Plaza17 West Broad St.Suite 210Bethlehem, PA 18018See Magellan’s website for a listing of member and provider phonenumbers: magellanofpa.comPerformCareCumberland, Dauphin, Franklin, Fulton, Lancaster, Lebanon, andPerry counties8040 Carlson RoadHarrisburg, PA 17112Value Behavioral Healthof Pennsylvania (VBH)520 Pleasant Valley RoadTrafford, PA 15085See PerformCare’s website for a listing of member and providerphone numbers: pa.performcare.orgArmstrong, Beaver, Butler, Crawford, Fayette, Greene, Indiana,Lawrence, Mercer, Venango, Washington, and Westmorelandcounties.See VBH’s website for a listing of member and provider phonenumbers: vbh-pa.comUPMC Health Plan 2021, effective 4-1-21. All rights reserved.upmchealthplan.com19
Welcome and Key Contacts – Chapter ATable A5: UPMC for You (Medical Assistance) Contacts (continued)ContactTelephone NumberCONNECT(Early intervention referral service forchildren from birth to 5 years)1-800-692-7288Statewide Information and Referral helplineconnectpa.comDental – SKYGEN USAskygenusa.comProvider Call UPMC for You Health Care Conciergeteam1-800-286-4242TTY: 711Early and Periodic Screening,Diagnosis, and Treatment (EPSDT)1-866-918-1595Fraud and Abuse Hotline(For UPMC Health Plan)1-866-372-8301TTY: 711HealthChoices HotlinePA Enrollment Support1-800-440-3989TTY: 1-800-618-4225Health Management Programs & CaseManagement(Specialized programs to improve thehealth of members)1-866-778-6073Fax: 412-454-7552Maternity ProgramUPMC Health Plan Maternity program 1-866-463-1462Fax: 412-454-8558Medical Assistance TransportationProgram (MATP)The member’s county of residence arranges thetransportation.(Provides transportation to medicalappointments.)See MATP’s website for the phone numbers of localMATP providers:matp.pa.gov/CountyContact.aspxOffice of Medical Assistance (OMAP)MA Provider Compliance Hotline1-866-379-8477Fax: 717-772-4655TTY: 1-866-379-8477UPMC Health Plan 2021, effective 4-1-21. All rights reserved.upmchealthplan.com20
Welcome and Key Contacts – Chapter ATable A5: UPMC for You (Medical Assistance) Contacts (continued)ContactTelephone NumberPennsylvania Department ofHuman Services (DHS)General Information1-800-537-8862Provider Hotline1-800-537-8862Electronic Verification System1-800-766-5387Pharmacy Services1-800-396-4139Fax: 412-454-7722Provider Network Management(For notifying UPMC HealthPlan of provider ge.htmlProvider Services1-866-918-1595Hours: Monday through Friday, 8 a.m. to 5 p.m.Renal CareESRD Care ManagersSpecial Needs UnitNote: If you are not able to complete the online form or ifyou do not receive confirmation that the submission hasbeen successful, please complete and fax the applicableform listed on the website to UPMC Health Plan at412-454-8225. If you have any questions or difficulties,please contact your physician account executive nday through Friday, 7 a.m. to 8 p.m.Saturday, 8 a.m. to 3 p.m.UPMC Health Plan 2021, effective 4-1-21. All rights reserved.upmchealthplan.com21
Welcome and Key Contacts – Chapter ATable A5: UPMC for You (Medical Assistance) Contacts (continued)ContactTelephone NumberTransportation ServicesUPMC Medical Transportation1-877-521-RIDE (7433)UPMC for You Health CareConcierge team1-800-286-4242TTY: 711Hours:7:00 a.m. to 7:00 p.m. - Monday, Tuesday, Thursday, Friday7:00 a.m. to 8:00 p.m. - Wednesday8:00 a.m. to 3:00 p.m. - SaturdayUPMC Health Plan Web Services(Web support)1-800-937-0438HPOnline@upmc.eduUPMC Health Plan Websiteupmchealthplan.comUtilization Management(Includes prior authorization andconcurrent review.)1-800-425-7800Hours: Monday through Friday, 8 a.m. to 4:30 p.m.Vaccines for Children (VFC)1-888-646-6864 (to enroll)Vision – EnvolveMember Services1-866-458-2138Provider Services1-866-458-2138TTY: 711UPMC Health Plan 2021, effective 4-1-21. All rights reserved.upmchealthplan.com22
Welcome and Key Contacts – Chapter ACloser Look at HealthChoicesThe HealthChoices Program is the name of Pennsylvania's mandatory managedcare programs for Medical Assistance recipients.The recipients have access to medical care and other appropriate physical healthservices, whether the services are delivered on an inpatient or outpatient basis,through a Physical Health Managed Care Organization. The Department of HumanServices’ Office of Medical Assistance Programs oversees the Physical Healthcomponent of the HealthChoices Program.Recipients receive behavioral health and/or drug and alcohol services through BehavioralHealth Managed Care Organizations. This component is overseen by the Department ofHuman Services’ Office of Mental Health and Substance Abuse Services.UPMC for You is one of the Physical Health Managed Care Organizations offeredto recipients in the following zones:Lehigh Capital ZoneAdams, Berks, Cum
Table A1: UPMC Behavioral Health Services (UPMC BHS) Contacts Contact Telephone Number Fraud and Abuse Hotline Number (For UPMC Health Plan) 1-866-372-8301 UPMC Behavioral Health Services Health Care Concierge team Behavioral Health Case Management Programs Behavioral Health UPMC for Kids (CHIP) 1-888-251-0083 TTY: 1-877-877-3580 1-888-777-8754
