UPMC Health Plan

Summary

UPMC Health Plan is a regional health plan, part of UPMC, offering dental, medical, and vision coverage operating in Pennsylvania. Claims route under payer ID 23281, with 9 alternate IDs in use across clearinghouses. Provider enrollment typically takes 60-90 days, with applications through UPMC Provider Portal, and CAQH is used for credentialing data. Through clearinghouses it supports eligibility checks, claim status inquiries, professional claims, institutional claims, dental claims, and electronic remittance (ERA); ERA enrollment is required and takes several weeks.

At a glance

Payer ID

23281Also seen as 10288, 23281MA, 23281MAP, 2803, 7543, 95216 and 3 more

Also known as

UPMC Dental Advantage, UPMC Health Plan (TriState), University of Pittsburgh Medical Center Dental Advantage, University of Pittsburgh Medical Center Health Plan

Uses CAQH

YesApplication route: Payer portal application

Service area

PA

Clearinghouse transaction setup

Which EDI transactions this payer supports, and how long clearinghouse enrollment typically takes when it is required.

Common questions

What is the payer ID for UPMC Health Plan?

The payer ID for UPMC Health Plan is 23281. Alternate IDs seen across clearinghouses include 10288, 23281MA, 23281MAP, 2803.

How long does UPMC Health Plan provider enrollment take?

UPMC Health Plan provider enrollment typically takes 60-90 days from application to effective date. Timelines vary by state, plan, and how complete the application is.

Does UPMC Health Plan require CAQH?

Yes. UPMC Health Plan uses CAQH for credentialing data, so keep the provider's CAQH profile current and attested before applying.

Does UPMC Health Plan require ERA enrollment?

Yes. UPMC Health Plan requires a separate ERA (835) enrollment before electronic remittances flow, and setup typically takes several weeks.

What states does UPMC Health Plan cover?

UPMC Health Plan operates in PA. Coverage can differ by plan and product line, so confirm the specific plan before you file.