Upload
lamdieu
View
220
Download
0
Embed Size (px)
Citation preview
Welcome and Key Contacts – Chapter A
Welcome and Key
Contacts
A.2 Welcome
A.3 Provider OnLine
A.4 UPMC Health Plan Website
A.5 How to Use This Manual
A.7 Key Contacts
A.8 Table A1 - UPMC Health Plan (Commercial)
A.10 Table A2 - UPMC for Kids (CHIP)
A.12 Table A3 - UPMC for You (Medical Assistance)
A.22 Table A4 - UPMC for Life (Medicare)
A.24 Table A5 - UPMC Medicare Special Needs Plans (SNP)
A.26 Table A6 - Other Program and Government Contacts
A.27 Table A7 – UPMC Health Plan Behavioral Health Services (BHS)
A.30 Table A8 – UPMC Community HealthChoices (CHC)
Welcome and Key Contacts – Chapter A
UPMC Health Plan www.upmchealthplan.com © 12-1-17 All rights reserved.
Pag
e2
Welcome Welcome to UPMC Health Plan, a provider-led health plan committed to quality coverage for its
members and employer clients.
Guided by the principle of treating others as we want to be treated, UPMC Health Plan’s goal is
to be the nation’s best service-centered health benefits company, providing the highest quality
products at an affordable price to families, individuals, and employers.
We pledge to satisfy customers, grow membership, control expenses, and improve the health of
people living in the communities we serve.
UPMC Health Plan was founded as a provider-led managed care organization. As such, UPMC
Health Plan has never placed barriers between doctor and patient. We consider the providers in
our network to be leaders in the quality of care they provide. Our goal as a health insurer is to
work with our providers to make sure our members get regular preventive care and quality
medical care, as well as to reduce unnecessary medical procedures.
To that end, this document is intended to serve as the main resource for information about
UPMC Health Plan’s products, services, and claims processes, and as a reference for providers
when questions arise. If certain situations require further explanation, providers should call
Provider Services from 8 a.m. to 5 p.m., Monday through Friday, at the following numbers:
UPMC Behavioral Health Services (BHS) 1-866-441-4185
UPMC Community HealthChoices 1-844-860-9303
UPMC for Kids (CHIP) 1-800-650-8762
UPMC for Life (Medicare) 1-877-539-3080
UPMC for You (Medical Assistance) 1-866-918-1595
UPMC Health Plan (Commercial) 1-866-918-1595
UPMC Medicare Special Needs Plans (SNP) 1-800-606-8648
Other help, including provider network directories, is also available online at
www.upmchealthplan.com.
Welcome and Key Contacts – Chapter A
UPMC Health Plan www.upmchealthplan.com © 12-1-17 All rights reserved.
Pag
e3
Provider OnLine Provider OnLine can significantly reduce the number of telephone calls providers need to
make to UPMC Health Plan, thereby reducing the time it takes to perform daily tasks.
This secure online service allows providers to check member eligibility and benefits, submit
claims for reimbursement, check on the status of a claim, and send and receive messages to
communicate with UPMC Health Plan personnel.
You can access Provider OnLine from www.upmchealthplan.com/providers. Enter your user
ID in the provider log-in box. If you do not have a Provider OnLine account, your practice
online account administrator will help you gain this access. (Note: the Online account
administrator is the individual within a practice who manages all Provider Online security and
access). If you do not have an Online account administrator, complete the first-time user
registration at:
https://upmchealthplan.upmc.com/WebPortals/Requests/SecurityRequest.aspx.
To view information about an eligible member, providers need one of the following:
• Member’s full name
• Member’s Social Security number
• Member’s identification number
The database shows the member’s specific benefits, including riders, and the date such
benefits became effective.
Physicians also can request authorization to prescribe certain medications.
UPMC Community HealthChoices Home and Community Based Services providers can
access Provider OnLine to check member eligibility and benefits but claims submission will
occur in HHAeXchange.
Welcome and Key Contacts – Chapter A
UPMC Health Plan www.upmchealthplan.com © 12-1-17 All rights reserved.
Pag
e4
UPMC Health Plan Website
UPMC Health Plan’s website is located at www.upmchealthplan.com.
Physicians and other providers can find the following information on UPMC Health Plan’s
website:
• 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 for
providers)
• Provider manual (hard copy or CD available upon request)
• Provider news
• UPMC Health Plan annual report
• Wellness information
Welcome and Key Contacts – Chapter A
UPMC Health Plan www.upmchealthplan.com © 12-1-17 All rights reserved.
Pag
e5
How to Use This Manual This manual provides physicians, hospitals, long-term service and support providers, and
other 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. This
manual directs users to important information through text call-out boxes. Samples of the call-
outs include:
Key Points
Key Points are major highlights about a particular topic. These points are listed in bullet form
for easy readability.
This chapter includes a list of Key Contacts. Throughout this manual there are important
phone numbers and addresses, all of which are printed in bold-face type.
This manual contains a dual-definition glossary. All terms include a common language
definition, and some may include a regulatory definition. Regulatory definitions are required
by regulatory and other government agencies and are standard to the insurance industry,
including UPMC Health Plan.
See Glossary and Abbreviations, Chapter K.
Closer Look at (Subject)
A Closer Look provides additional information about a topic, such as an
important phone number, address, or useful fact.
Alert
An Alert draws attention to critical information.
Welcome and Key Contacts – Chapter A
UPMC Health Plan www.upmchealthplan.com © 12-1-17 All rights reserved.
Pag
e6
UPMC Health Plan will update this manual and post revisions as needed. The bottom of each
page 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 Health
Coverage Inc., and UPMC for You Inc.
Welcome and Key Contacts – Chapter A
UPMC Health Plan www.upmchealthplan.com © 12-1-17 All rights reserved.
Pag
e7
Key Contacts
The following tables include all of the important telephone and fax numbers listed in the
UPMC Health Plan Provider Manual. Before calling Provider Services, please have the
following information available:
• Provider’s tax identification (ID) number (preferred) or UPMC Health Plan
provider number
• The member’s identification number
• The phone number of the telephone from which the call is made
Table A1: UPMC Health Plan (Commercial) Contacts
Table A2: UPMC for Kids (CHIP) Contacts
Table A3: UPMC for You (Medical Assistance) Contacts
Table A4: UPMC for Life (Medicare) Contacts
Table A5: UPMC Medicare Special Needs Plans (SNP) Contacts
Table A6: Other Program and Government Contacts
Table A7: UPMC Health Plan Behavioral Health Services (BHS) Contacts
Table A8: UPMC Community HealthChoices (CHC) Contacts
Welcome and Key Contacts – Chapter A
UPMC Health Plan www.upmchealthplan.com © 12-1-17 All rights reserved.
Pag
e8
Table A1: UPMC Health Plan (Commercial) Contacts
Contact Telephone Number
Assist America 1-800-872-1414 (within U.S.)
1-301-656-4152 (outside U.S.)
1-609-986-1234 (inside U.S.)
Behavioral Health Services
UPMC Health Plan Behavioral Health
Services (BHS)
Provider Services
Member Services
1-866-441-4185
1-888-251-0083
Fraud and Abuse Hotline
(for UPMC Health Plan)
1-866-372-8301
TTY: 1-800-361-2629
Health Management & Case
Management
(specialized programs to
improve the health of members)
1-866-778-6073
Fax: 412-454-7552
Laboratory Services
Associated Clinical Laboratories
(Northern Pennsylvania)
1-800-937-8028
Quest Diagnostics, Inc.
(Southern Pennsylvania)
1-800-920-9220
Maternity Program
UPMC Health Plan Maternity
Program
1-866-778-6073
Fax: 412-454-8558
Medical Management
(includes prior authorization and
concurrent review)
1-800-425-7800
Fax: 412-454-2057
Hours: Monday through Friday ,8 a.m. to 4:30 p.m.
UPMC Health Plan (Commercial)
Health Care Concierge Team
1-888-876-2756
TTY: 1-800-361-2629
UPMC Advantage
Health Care Concierge Team
1-866-353-3598
Welcome and Key Contacts – Chapter A
UPMC Health Plan www.upmchealthplan.com © 12-1-17 All rights reserved.
Pag
e9
Table A1: UPMC Health Plan (Commercial) Contacts (continued)
Contact Telephone Number
Pharmacy Services
1-800-979-8762
Fax: 412-454-7722
Express Scripts
(mail order)
1-877-787-6279
Fax: 1-800-636-9494
TTY: 1-800-899-2114
Accredo
(mail order – for specialty medications
only)
1-888-853-5525
Provider Network Management
(for notifying UPMC Health Plan of
provider practice changes)
Fax: 412-454-5664
www.upmchealthplan.com/providers/change.html
Provider Services
1-866-918-1595
Hours: Monday through Friday from 8 a.m. to 5 p.m.
Renal Care
ESRD Care Managers
1-866-778-6073
UPMC Health Plan Web Services
(Web support)
1-800-937-0438
UPMC Health Plan Website www.upmchealthplan.com
UPMC Medical Transport 1-877-521-RIDE (7433)
Vision:
UPMC Vision Care
Member Services
Provider Services
UPMC Vision Advantage
Member Services
Provider Services
1-844-252-0687
1-877-262-7870
1-888-499-6914
1-877-648-9621
Welcome and Key Contacts – Chapter A
UPMC Health Plan www.upmchealthplan.com © 12-1-17 All rights reserved.
Pag
e10
Table A2: UPMC for Kids (CHIP) Contacts
Contact Telephone Number
Behavioral Health Services
UPMC Health Plan Behavioral
Health Services (BHS)
Provider Services
1-866-441-4185
Dental – Avesis
Provider Services
Member Services
1-888-209-1243
Fax: 1-866-653-5544 (Secure)
1-888-257-0350
TTY:1-800-361-2629
Fraud and Abuse Hotline
(for UPMC Health Plan)
1-866-372-8301
TTY: 1-800-361-2629
Health Management & Case
Management
(specialized programs to improve
the health of members)
1-866-778-6073
Fax: 412-454-7552
Laboratory Services
Associated Clinical Laboratories
(Northern Pennsylvania)
1-800-937-8028
Quest Diagnostics, Inc.
(Southern Pennsylvania)
1-800-920-9220
Maternity Program
UPMC Health Plan maternity
program
1-866-463-1462
Fax: 412-454-8558
Medical Management
(includes prior authorization and
concurrent review)
1-800-425-7800
Fax: 412-454-2057
Hours: Monday through Friday, 8 a.m. to 4:30 p.m.
UPMC for Kids
Health Care Concierge Team
1-800-650-8762
TTY: 1-800-361-2629
Welcome and Key Contacts – Chapter A
UPMC Health Plan www.upmchealthplan.com © 12-1-17 All rights reserved.
Pag
e11
Table A2: UPMC for Kids (CHIP) Contacts (continued)
Contact Telephone Number
Pharmacy Services 1-800-979-8762
Fax: 412-454-7722
Express Scripts
(mail order)
1-877-787-6279
Fax: 1-800-636-9494
TTY: 1-800-899-2114
Accredo Pharmacy
(mail order – for specialty
medications only)
1-888-853-5525
Provider Network Management
(for notifying the Health Plan of
provider practice changes)
Fax: 412-454-5664
www.upmchealthplan.com/providers/change.html
Provider Services
1-800-650-8762
1-866-918-1595
Hours: Monday through Friday, 8 a.m. to 5 p.m.
UPMC Medical Transport 1-877-521-RIDE (7433)
UPMC Health Plan Web Services
(Web support)
1-800-937-0438
UPMC Health Plan Website
www.upmchealthplan.com
Vision – Envolve
Member Services 1-866-921-7965
Provider Services 1-866-921-7965
TTY: 1-800-361-2629
Welcome and Key Contacts – Chapter A
UPMC Health Plan www.upmchealthplan.com © 12-1-17 All rights reserved.
Pag
e12
Table A3: UPMC for You (Medical Assistance) Contacts
Contact Telephone Number
Behavioral Health Services – Managed Care Organizations (BH-MCO)
Community Care Behavioral Health
Organization (CCBHO)
Adams, Allegheny, Berks, Blair, Cameron, Clarion,
Clearfield, Elk, Erie, Forest, Huntingdon, Jefferson,
McKean, Potter, Warren, and York counties.
339 Sixth Avenue
Suite 1300
Pittsburgh, PA 15222
(See listing below for phone numbers by county.)
www.ccbh.com
Magellan Behavioral Health of
Pennsylvania (MBH)
One Bethlehem Plaza
17 West Broad St.
Suite 210
Bethlehem, PA 18018
Lehigh and Northampton counties.
(See listing below for phone numbers by county.)
www.magellanofpa.com
PerformCare
8040 Carlson Road
Harrisburg, PA 17112
http://pa.performcare.org
Bedford, Cumberland, Dauphin, Franklin, Fulton,
Lancaster, Lebanon, Perry, and Somerset counties
(See listing below for phone numbers by county.)
Value Behavioral Health of
Pennsylvania (VBH)
520 Pleasant Valley Road
Trafford, PA 15085
Armstrong, Beaver, Butler, Cambria, Crawford,
Fayette, Greene, Indiana, Lawrence, Mercer, Venango,
Washington, and Westmoreland counties.
(See listing below for phone numbers by county.)
www.vbh-pa.com
Welcome and Key Contacts – Chapter A
UPMC Health Plan www.upmchealthplan.com © 12-1-17 All rights reserved.
Pag
e13
Table A3: UPMC for You (Medical Assistance) Contacts (continued)
Contact Telephone Number
BH-MCO by Counties Member Services
Numbers
Provider Services
Numbers
Adams CCBHO 1-866-738-9849
TTY: 1-877-877-3580
Spanish line:
1-866-229-3187
1-888-251-2224
Clinical fax:
1-866-418-0366
Allegheny CCBHO 1-800-553-7499
TTY: 1-877-877-3580
Spanish line:
1-866-229-3187
1-888-251-2224
Clinical fax:
1-888-251-0087
Armstrong VBH 1-877-688-5969
TTY: 1-877-615-8502
1-877-615-8503
Beaver VBH 1-877-688-5970
TTY: 1-877-615-8502
1-877-615-8503
Bedford PerformCare 1-866-773-7891
TTY: 1-800-654-5984 or
PA Relay 711
1-888-700-7370
Berks CCBHO 1-866-292-7886
TTY: 1-877-877-3580
Spanish line:
1-866-229-3187
1-888-251-2224
Clinical fax:
1-866-418-0366
Blair CCBHO 1-855-520-9715
TTY: 1-800-877-3580
Spanish line:
1-866-229-3187
1-888-251-2224
Clinical fax:
1-866-418-0366
Butler VBH 1-877-688-5971
TTY: 1-877-615-8502
1-877-615-8503
Cambria VBH 1-866-404-4562
TTY: 1-877-615-8502
1-877-615-8503
Fax: 1-855-439-2447
Cameron CCBHO 1-866-878-6046
TTY: 1-877-877-3580
Spanish line:
1-866-229-3187
1-888-251-2224
Clinical fax:
1-866-294-3935
Clarion CCBHO 1-866-878-6046
TTY: 1-877-877-3580
Spanish line:
1-866-229-3187
1-888-251-2224
Clinical fax:
1-866-294-3935
Clearfield CCBHO 1-866-878-6046
TTY: 1-877-877-3580
Spanish line:
1-866-229-3187
1-888-251-2224
Clinical fax:
1-866-294-3935
Welcome and Key Contacts – Chapter A
UPMC Health Plan www.upmchealthplan.com © 12-1-17 All rights reserved.
Pag
e14
Table A3: UPMC for You (Medical Assistance) Contacts (continued)
Contact Telephone Number
BH-MCO by Counties Member Services
Numbers
Provider Services
Numbers
Crawford VBH 1-866-404-4561
TTY: 1-877-615-8502
1-877-615-8503
Cumberland PerformCare 1-888-722-8646
TTY: 1-800-654-5984 or
PA Relay 711
1-888-700-7370
Dauphin PerformCare 1-888-722-8646
TTY: 1-800-654-5984, or
PA Relay 711
1-888-700-7370
Elk CCBHO 1-866-878-6046
TTY: 1-877-877-3580
Spanish line:
1-866-229-3187
1-888-251-2224
Clinical fax:
1-866-294-3935
Erie CCBHO 1-855-224-1777
TTY: 1-877-877-3580
Spanish line:
1-866-229-3187
1-888-251-2224
Clinical fax:
1-855-892-8495
Fayette VBH 1-877-688-5972
TTY: 1-877-615-8502
1-877-615-8503
Forest CCBHO 1-866-878-6046
TTY: 1-877-877-3580
Spanish line:
1-866-229-3187
1-888-251-2224
Clinical fax:
1-866-294-3935
Franklin PerformCare 1-866-773-7917
TTY: 1-800-654-5984 or
PA Relay 711
1-888-700-7370
Fulton PerformCare 1-866-773-7917
TTY: 1-800-654-5984 or
PA Relay 711
1-866-773-7917
Fax: 1-888-296-4002
Fax: 717-671-6522
Greene VBH 1-877-688-5973
TTY: 1-877-615-8502
1-877-615-8503
Huntingdon CCBHO 1-866-878-6046
TTY: 1-877-877-3580
Spanish line:
1-866-229-3187
1-888-251-2224
Clinical fax:
1-866-294-3935
Indiana VBH 1-877-688-5969
TTY: 1-877-615-8502
1-877-615-8503
Jefferson CCBHO 1-866-878-6046
TTY: 1-877-877-3580
Spanish line:
1-866-229-3187
1-888-251-2224
Clinical fax:
1-866-294-3935
Welcome and Key Contacts – Chapter A
UPMC Health Plan www.upmchealthplan.com © 12-1-17 All rights reserved.
Pag
e15
Table A3: UPMC for You (Medical Assistance) Contacts (continued)
Contact Telephone Number
BH-MCO by Counties Member Services
Numbers
Provider Services
Numbers
Lancaster PerformCare 1-888-722-8646
TTY: 1-800-654-5984 or
PA Relay 711
1-888-700-7370
Lawrence VBH 1-877-688-5975
TTY: 1-877-615-8502
1-877-615-8503
Lebanon PerformCare 1-888-722-8646
TTY: 1-800-654-5984 or
PA Relay 711
1-888-700-7370
Lehigh MBH 1-866-238-2312
TTY: 1-866-238-2313
1-866-780-3368
1-866-542-0299
McKean CCBHO 1-866-878-6046
TTY: 1-877-877-3580
Spanish line:
1-866-229-3187
1-888-251-2224
Clinical fax:
1-866-294-3935
Mercer VBH 1-866-404-4561
TTY: 1-877-615-8502
1-877-615-8503
Northampton MBH 1-866-238-2312
TTY: 1-866-238-2313
1-866-780-3368
1-866-542-0299
Perry PerformCare 1-888-722-8646
TTY: 1-800-654-5984 or
PA Relay 711
1-888-700-7370
Potter CCBHO 1-866-878-6046
TTY: 1-877-877-3580
Spanish line:
1-866-229-3187
1-888-251-2224
Clinical fax:
1-866-294-3935
Somerset PerformCare 1-866-773-7891
TTY: 1-800-654-5984 or
PA Relay 711
1-888-700-7370
Venango VBH 1-866-404-4561
TTY: 1-877-615-8502
1-877-615-8503
Warren CCBHO 1-866-878-6046
TTY: 1-877-877-3580
Spanish line:
1-866-229-3187
1-888-251-2224
Clinical fax:
1-866-294-3935
Washington VBH 1-877-688-5976
TTY: 1-877-615-8502
1-877-615-8503
Westmoreland VBH 1-877-688-5977
TTY: 1-877-615-8502
1-877-615-8503
York CCBHO 1-866-542-0299
TTY: 1-877-877-3580
Spanish line:
1-866-229-3187
1-888-251-2224
Clinical fax:
1-866-418-0366
Welcome and Key Contacts – Chapter A
UPMC Health Plan www.upmchealthplan.com © 12-1-17 All rights reserved.
Pag
e16
Table A3: UPMC for You (Medical Assistance) Contacts (continued)
Contact Telephone Number
CONNECT
(early intervention referral service for
children from birth to 5 years)
1-800-692-7288
Statewide Information and Referral helpline
Dental – Avesis
Provider Services
1-888-209-1243
Fax: 1-866-653-5544 (Secure)
Member Services
1-888-257-0474
TTY: 1-800-201-7165
EPSDT
1-866-463-1462
Fraud and Abuse Hotline
(for UPMC Health Plan)
1-866-372-8301
TTY: 1-800-361-2629
HealthChoices Hotline
PA Enrollment Support
1-800-440-3989
TTY: 1-800-618-4225
Health Management & Case
Management
(specialized programs to improve the
health of members)
1-866-778-6073
Fax: 412-454-7552
Maternity Program
UPMC Health Plan Maternity program
1-866-778-6073
Fax: 412-454-8558
Welcome and Key Contacts – Chapter A
UPMC Health Plan www.upmchealthplan.com © 12-1-17 All rights reserved.
Pag
e17
Table A3: UPMC for You (Medical Assistance) Contacts (continued)
Contact Telephone Number
Medical Assistance Transportation Program (MATP)
County Local Number Toll-Free Number
Adams 717-337-1345 1-800-830-6473
Allegheny 412-350-6100 1-888-547-6287
Armstrong 724-548-3408 1-800-468-7771
Beaver 724-375-2895 1-800-262-0343
Bedford 814-623-9129 1-800-323-9997
Berks 610-921-2361 1-800-383-2278
Blair 814-946-1235 1-800-245-3282
Butler 724-545-3669 1-866-638-0598
Cambria 814-536-9031 1-888-647-4814
Cameron 1-866-282-4968 1-866-282-4968
Clarion 814-226-7012 1-800-672-7116
Clearfield 814-765-1551 1-800-822-2610
Crawford 814-333-7090 1-800-210-6226
Cumberland 717-240-6340 1-800-315-2546
Dauphin 717-232-7009 1-800-309-8905
Elk 1-866-282-4968 1-866-282-4968
Erie 814-455-3330 none
Fayette 724-628-7433 1-800-321-7433
Forest 814-927-8266 1-800-222-1706
Fulton 717-485-0931 1-888-329-2376
Franklin 717-264-5225 1-800-548-5600
Greene 724-627-6778 1-877-360-7433
Huntingdon 814-641-6408 1-800-817-3383
Indiana 724-463-3235 1-888-526-6060
Jefferson 814-938-3302 1-800-648-3381
Lancaster 717-291-1243 1-800-892-1122
Lawrence 724-652-5588 1-888-252-5104
Lebanon 717-273-9328 none
Lehigh 610-253-8333 1-888-253-8333
McKean 1-866-282-4968 1-866-282-4968
Mercer 724-662-6222 1-800-222-8797
Northampton 610-253-8333 1-888-253-8333
Welcome and Key Contacts – Chapter A
UPMC Health Plan www.upmchealthplan.com © 12-1-17 All rights reserved.
Pag
e18
Table A3: UPMC for You (Medical Assistance) Contacts (continued)
Contact Telephone Number
Medical Assistance Transportation Program (MATP)
County Local Number Toll-Free Number
Perry 717-567-2490 1-877-800-7433
Potter 814-544-7315 1-800-800-2560
Somerset 814-445-9628 1-800-452-0241
Venango 814-432-9767 1-877-836-4699
Warren 814-723-1874 1-877-723-9456
Washington 724-223-8747 1-800-331-5058
Westmoreland 724-832-2703
(Urgent care line for rides)
1-800-242-2706
York 717-845-7553 1-800-632-9063
Welcome and Key Contacts – Chapter A
UPMC Health Plan www.upmchealthplan.com © 12-1-17 All rights reserved.
Pag
e19
Table A3: UPMC for You (Medical Assistance) Contacts (continued)
Contact Telephone Number
Medical Management
(includes prior authorization and
concurrent review)
1-800-425-7800
Fax: 412-454-2057
Hours:
Monday through Friday, 8 a.m. to 4:30 p.m.
UPMC for You
Health Care Concierge Team
1-800-286-4242
TTY: 1-800-361-2629
Hours:
7:00 a.m. to 7:00 p.m. - Monday, Tuesday, Thursday, Friday
7 a.m. to 8 p.m. - Wednesday
8:00 a.m. to 3:00 p.m. - Saturday
Office of Medical Assistance
(OMAP) MA Provider
Compliance Hotline
1-866-379-8477
Fax: 717-772-4655
TTY: 1-866-379-8477
Pennsylvania Department of
Human Services (DHS)
General Information
Provider Hotline
Electronic Verification System
1-800-537-8862
1-800-537-8862
1-800-766-5387
Pharmacy Services
1-800-396-4139
Fax: 412-454-7722
Accredo Pharmacy
(mail order – for specialty
medications only)
1-888-853-5525
Provider Network Management
(for notifying the Health Plan of
provider practice changes)
Fax: 412-454-5664
www.upmchealthplan.com/providers/change.html
Provider Services
1-866-918-1595
Hours: Monday through Friday, 8 a.m. to 5 p.m.
Renal Care
ESRD Care Managers
1-866-778-6073
Special Needs Unit 1-866-463-1462
Hours:
Monday through Friday, 7 a.m. to 8 p.m.
Saturday, 8 a.m. to 3 p.m.
Welcome and Key Contacts – Chapter A
UPMC Health Plan www.upmchealthplan.com © 12-1-17 All rights reserved.
Pag
e20
Table A3: UPMC for You (Medical Assistance) Contacts (continued)
Contact Telephone Number
Transportation Services UPMC
Medical Transportation
1-877-521-RIDE (7433)
UPMC Health Plan Web Services
(Web support)
1-800-937-0438
UPMC Health Plan Website
www.upmchealthplan.com
Vaccines for Children (VFC) 1-888-646-6864 (to enroll)
Vision – Envolve
Member Services
Provider Services
1-866-458-2138
1-866-458-2138
TTY: 1-800-361-2629
Welcome and Key Contacts – Chapter A
UPMC Health Plan www.upmchealthplan.com © 12-1-17 All rights reserved.
Pag
e21
Closer Look at Health Choices**
**The HealthChoices Program is the name of Pennsylvania's mandatory managed
care programs for Medical Assistance recipients.
The recipients have access to medical care and other appropriate physical health
services, whether the services are delivered on an inpatient or outpatient basis,
through a Physical Health Managed Care Organization. The Department of Human
Services’ Office of Medical Assistance Programs oversees the Physical Health
component of the HealthChoices Program.
Recipients receive behavioral health and/or drug and alcohol services through
Behavioral Health Managed Care Organizations. This component is overseen by the
Department of Human Services’ Office of Mental Health and Substance Abuse
Services.
UPMC for You is one of the Physical Health Managed Care Organizations offered to
recipients in the following zones:
Lehigh Capital
Zone
Adams, Berks, Cumberland, Dauphin, Franklin,
Fulton, Huntingdon, Lancaster, Lebanon, Lehigh,
Northampton, Perry, and York counties
New West Zone Cameron, Clarion, Clearfield, Crawford, Elk, Erie,
Forest, Jefferson, McKean, Mercer, Potter,
Venango, and Warren counties
Southwest Zone Allegheny, Armstrong, Beaver, Bedford, Blair,
Butler, Cambria, Fayette, Green, Indiana, Lawrence,
Somerset, Washington, and Westmoreland counties
Welcome and Key Contacts – Chapter A
UPMC Health Plan www.upmchealthplan.com © 12-1-17 All rights reserved.
Pag
e22
Table A4: UPMC for Life (Medicare) Contacts
Contact Telephone number
Assist America 1-800-872-1414 (within U.S.)
1-301-656-4152 (outside U.S.)
1-609-986-1234 (within U.S.)
Behavioral Health Services
UPMC Health Plan Behavioral Health
Services (BHS)
1-866-441-4185
Member Services 1-888-251-0083
TTY: 1-877-877-3580
Dental – Avesis (select employee group plans ONLY)
Provider Services
Member Services
1-888-209-1243
Fax: 1-866-653-5544 (Secure)
1-888-257-0066
TTY: 1-800-201-7165
Fraud and Abuse Hotline
(for UPMC Health Plan)
1-866-372-8301
TTY: 1-800-361-2629
Health Management & Case
Management
(specialized programs to improve the
health of members)
1-866-778-6073
Fax: 412-454-7551
Maternity Program
UPMC Health Plan Care Management
1-866-778-6073
Fax: 412-454-8558
Medical Management
(includes prior authorization and
concurrent review)
1-800-425-7800
Fax: 412-454-2057
Hours:
Monday through Friday, 8 a.m. to 4:30 p.m.
Medicare Hotline
(general services)
1-800-MEDICARE (633-4227)
UPMC for Life
Healthcare Concierge Team
1-877-539-3080
TTY: 1-800-361-2629
Case Management 1-866-778-6073
Fax: 412-454-7552
Welcome and Key Contacts – Chapter A
UPMC Health Plan www.upmchealthplan.com © 12-1-17 All rights reserved.
Pag
e23
Table A4: UPMC for Life (Medicare) Contacts (continued)
Contact Telephone number
Pharmacy Services
1-800-979-8762
Fax: 412-454-7722
Express Scripts
(mail order)
1-877-787-6279
Fax: 1-800-636-9494
TTY: 1-800-899-2114
Accredo Pharmacy
(mail order – for specialty
medications only)
1-866-848-9870
Fax: 1-888-773-7386
TTY: 1-800-955-8770
Provider Network Management
(for notifying the Health Plan of
provider practice changes)
Fax: 412-454-8225
www.upmchealthplan.com/providers/change.html
Provider Services
1-877-539-3080
1-866-918-1595
Hours:
Monday through Friday, 8 a.m. to 5 p.m.
Renal Care
ESRD Care Managers
1-866-778-6073
UPMC Health Plan Web Services
(Web support)
1-800-937-0438
UPMC Health Plan Website
www.upmchealthplan.com
UPMC Medical Transport
1-877-521-RIDE (7433)
Vision – UPMC Vision Care
Member Services
Provider Services
1-877-539-3080
1-877-262-7870
TTY: 1-800-361-2629
Welcome and Key Contacts – Chapter A
UPMC Health Plan www.upmchealthplan.com © 12-1-17 All rights reserved.
Pag
e24
Table A5: UPMC Medicare Special Needs Plans (SNP) Contacts
Contact Telephone Number
Assist America 1-800-872-1414 (within U.S.)
1-301-656-4152 (outside U.S.)
1-609-986-1234 (within U.S.)
Behavioral Health Services
UPMC Health Plan Behavioral
Health Services (BHS)
1-866-441-4185
TTY: 1-877-877-3580
Dental - Avesis
Provider Services
Member Services
1-888-729-7951
1-866-918-1595
1-800-606-8648
TTY: 1-866-407-8762
Fraud and Abuse Hotline
(for UPMC Health Plan)
1-866-372-8301
TTY: 1-800-361-2629
Health Management & Case
Management
(specialized programs to improve
the health of members)
1-866-778-6073
Fax: 412-454-7552
Maternity Program
UPMC Health Plan Maternity
Program
1-866-463-1462
Fax: 412-454-8558
Medical Management
(includes prior authorization and
concurrent review)
1-800-425-7800
Fax: 412-454-2057
Hours:
Monday through Friday, 8 a.m. to 4:30 p.m.
UPMC Medicare Special Needs
Plan Health Care Concierge Team
1-800-606-8648
TTY: 1-866-407-8762
Pharmacy Services
1-800-396-4139
Fax: 412-454-7722
Express Scripts
(mail order)
1-888-289-1405
Fax: 1-800-636-9494
TYY: 1-800-899-2114
Accredo Pharmacy
(mail order – for specialty
medications only)
1-888-853-5525
Welcome and Key Contacts – Chapter A
UPMC Health Plan www.upmchealthplan.com © 12-1-17 All rights reserved.
Pag
e25
Table A5: UPMC Medicare Special Needs Plans (SNP) Contacts
(continued)
Contact Telephone Number
Provider Network Management
(for notifying the Health Plan of
provider practice changes)
Fax: 412-454-5664
www.upmchealthplan.com/providers/change.html
Provider Services 1-800-606-8648
1-866-918-1595
Hours: Monday through Friday, 8 a.m. to 5 p.m.
UPMC Health Plan Web
Services
(Web support)
1-800-937-0438
UPMC Health Plan Website
www.upmchealthplan.com/snp
UPMC Medical Transport 1-877-521-RIDE (7433)
Vision – UPMC Vision Care
Member Services
Provider Services
1-800-606-8648
1-877-262-7870
TTY: 1-866-407-8762
Welcome and Key Contacts – Chapter A
UPMC Health Plan www.upmchealthplan.com © 12-1-17 All rights reserved.
Pag
e26
Table A6: Other Program and Government Contacts
Contact Telephone Number
Office of the Inspector General
- National Fraud Hotline
1-800-HHS-TIPS (447-8477)
Pennsylvania Department of Health
- Bureau of Managed Care
1-888-466-2787
Pennsylvania Insurance Department
- Bureau of Consumer Affairs
1-877-881-6388
Pennsylvania Medical Society
- Division of Communication
and Public Affairs
1-800-228-7823
Welcome and Key Contacts – Chapter A
UPMC Health Plan www.upmchealthplan.com © 12-1-17 All rights reserved.
Pag
e27
Table A7: UPMC Health Plan Behavioral Health Services (BHS)
Contacts
Contact Telephone Number
UPMC Health Plan Behavioral
Health Service Corporate Offices
UPMC Health Plan
U.S. Steel Tower
600 Grant St
Pittsburgh, PA 15219
Provider Contracting and
Credentialing
Community Care Behavioral Health Organization
(CCBHO)
339 Sixth Avenue
Suite 1300
Pittsburgh, PA 15222
www.ccbh.com
Provider Voice Line 1-866-441-4185
(24 hours a day, seven days a week)
Provider Fax Line
Authorization Forms
Other Clinical Information
Fax: 1-888-249-5646
Fax: 1-888-251-0087
Member Services
Behavioral Health Case
Management Programs
Behavioral Health UPMC for Kids
(CHIP)
1-888-251-0083
TTY: 1-877-877-3580
1-888-777-8754
1-800-650-8762
All Member Services lines answer 24 hours a day, seven
days a week.
Routine questions are best answered by calling during
business hours: Monday through Friday, 8 a.m. to 5 p.m.
UPMC Health Plan Claims
Department
1-888-876-2756
Fraud and Abuse Hotline Number
(for UPMC Health Plan)
1-866-372-8301
Welcome and Key Contacts – Chapter A
UPMC Health Plan www.upmchealthplan.com © 12-1-17 All rights reserved.
Pag
e28
Table A7: UPMC Health Plan Behavioral Health Services (BHS)
Contacts (continued)
Contact Telephone Number
Provider Reference Materials
Behavioral Health Provider
alerts, newsletter articles, and
forms
The Mental Health Medical
Necessity Criteria Set
(utilized by UPMC Health Plan
BHS)
• The Mihalik Group's
Medical Necessity
Manual for Behavioral
Health, Version 6.0.0
• The Chemical
Dependency Medical
Necessity Criteria Sets
Adults
Children and Adolescents
www.upmchealthplan.com/providers/patient_index.html
www.themihalikgroup.com
For password assistance: 1-773-929-1722
Pennsylvania Client Placement Criteria, 2nd edition
Department of Health, Bureau of Drug and
Alcohol Programs
Room 929
Health and Welfare Building
Harrisburg, PA 17108
American Society for Addiction Medicine (ASAM),
Patient Placement Criteria (PPC-2R) ASAM
Publications Distribution Center
PO Box 101
Annapolis Junction, MD 20701-0101
1-800-844-8948
www.asam.org
Welcome and Key Contacts – Chapter A
UPMC Health Plan www.upmchealthplan.com © 12-1-17 All rights reserved.
Pag
e29
Table A7: UPMC Health Plan Behavioral Health Services (BHS)
Contacts (continued)
Contact Telephone Number
Additional Sources to obtain a
copy of the Medical Necessity
Criteria:
UPMC Health Plan Behavioral
Health Services
1-866-441-4185
Representatives are available 24 hours a day, seven days a
week.
Welcome and Key Contacts – Chapter A
UPMC Health Plan www.upmchealthplan.com © 12-1-17 All rights reserved.
Pag
e30
Table A8: UPMC Community HealthChoices Contacts
Contact Telephone Number
Behavioral Health Services – Managed Care Organizations (BH-MCO)
Community Care Behavioral Health
Organization (CCBHO)
339 Sixth Avenue
Suite 1300
Pittsburgh, PA 15222
www.ccbh.com
Adams, Allegheny, 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, Sullivan,
Susquehanna, Tioga, Union, Warren,
Wayne, Wyoming, and York counties.
(See listing below for phone numbers by
county.)
Community Behavioral Health (CBH)
801 Market Street
Suite 7000
Philadelphia, PA 19107
www.dbhids.org/
Philadelphia
(See listing below for phone number by
county)
Magellan Behavioral Health of Pennsylvania
(MBH)
One Bethlehem Plaza
17 West Broad St.
Suite 210
Bethlehem, PA 18018
www.magellanofpa.com
Bucks, Cambria, Delaware, Lehigh,
Montgomery and Northampton counties.
(See listing below for phone numbers by
county.)
Welcome and Key Contacts – Chapter A
UPMC Health Plan www.upmchealthplan.com © 12-1-17 All rights reserved.
Pag
e31
Table A8: UPMC Community HealthChoices Contacts (Continued)
Contact Phone Number
Behavioral Health Services – Managed Care Organizations (BH-MCO)
PerformCare
8040 Carlson Road
Harrisburg, PA 17112
http://pa.performcare.org
Bedford, Cumberland, Dauphin, Franklin, Fulton,
Lancaster, Lebanon, Perry, and Somerset counties.
(See listing below for phone numbers by county.)
Value Behavioral Health of
Pennsylvania (VBH)
520 Pleasant Valley Road
Trafford, PA 15085
www.vbh-pa.com
Armstrong, Beaver, Butler, Crawford, Fayette, Greene,
Indiana, Lawrence, Mercer, Venango, Washington, and
Westmoreland counties.
(See listing below for phone numbers by county.)
Welcome and Key Contacts – Chapter A
UPMC Health Plan www.upmchealthplan.com © 12-1-17 All rights reserved.
Pag
e32
Table A8: UPMC Community HealthChoices Contacts (Continued)
Contact Telephone Number
BH-MCO by Counties Member Services Numbers
Provider Services
Numbers
Adams CCBHO 1-866-738-9849
TTY: 1-877-877-3580
Spanish line:
1-866-229-3187
1-888-251-2224
Clinical fax:
1-866-418-0366
Allegheny CCBHO 1-800-553-7499
TTY: 1-877-877-3580
Spanish line:
1-866-229-3187
1-888-251-2224
Clinical fax:
1-888-251-0087
Armstrong VBH 1-877-688-5969
TTY: 1-877-615-8502
1-877-615-8503
Beaver VBH 1-877-688-5970
TTY: 1-877-615-8502
1-877-615-8503
Bedford PerformCare 1-866-773-7891
TTY: 1-800-654-5984 or
PA Relay 711
1-888-700-7370
Berks CCBHO 1-866-292-7886
TTY: 1-877-877-3580
Spanish line:
1-866-229-3187
1-888-251-2224
Clinical fax:
1-866-418-0366
Blair CCBHO 1-855-520-9715
TTY: 1-800-877-3580
Spanish line:
1-866-229-3187
1-888-251-2224
Clinical fax:
1-866-418-0366
Bradford CCBHO 1-866-878-6046
TTY: 1-877-877-3580
Spanish line:
1-866-229-3187
1-888-251-2224
Clinical fax:
1-866-558-2618
Bucks MBH 1-877-769-9784
TTY: 1-877-769-9785
1-877-769-9779
Butler VBH 1-877-688-5971
TTY: 1-877-615-8502
1-877-615-8503
Cambria VBH 1-866-404-4562
TTY: 1-877-615-8502
1-877-615-8503
Fax: 1-855-439-2447
Welcome and Key Contacts – Chapter A
UPMC Health Plan www.upmchealthplan.com © 12-1-17 All rights reserved.
Pag
e33
Table A8: UPMC Community HealthChoices Contacts (Continued)
Contact Telephone Number
BH-MCO by Counties Member Services
Numbers
Provider Services
Numbers
Carbon CCBHO 1-866-878-6046
TTY: 1-877-877-3580
Spanish line:
1-866-229-3187
1-888-251-2224
Clinical fax:
1-866-294-3935
Cameron CCBHO 1-866-878-6046
TTY: 1-877-877-3580
Spanish line:
1-866-229-3187
1-888-251-2224
Clinical fax:
1-866-294-3935
Centre CCBHO 1-866-878-6046
TTY: 1-877-877-3580
Spanish line:
1-866-229-3187
1-888-251-2224
Clinical fax:
1-866-562-2406
Chester CCBHO 1-866-662-4228
TTY: 1-877-877-3580
Spanish line:
1-866-229-3187
1-888-251-2224
Clinical fax:
1-888-589-6559
Clarion CCBHO 1-866-878-6046
TTY: 1-877-877-3580
Spanish line:
1-866-229-3187
1-888-251-2224
Clinical fax:
1-866-294-3935
Clearfield CCBHO 1-866-878-6046
TTY: 1-877-877-3580
Spanish line:
1-866-229-3187
1-888-251-2224
Clinical fax:
1-866-294-3935
Clinton CCBHO 1-855-520-9787
TTY: 1-877-877-3580
Spanish line:
1-866-229-3187
1-888-251-2224
Clinical fax:
1-866-562-2406
Columbia CCBHO 1-866-878-6046
TTY: 1-877-877-3580
Spanish line:
1-866-229-3187
1-888-251-2224
Clinical fax:
1-866-558-2618
Crawford VBH 1-866-404-4561
TTY: 1-877-615-8502
1-877-615-8503
Cumberland PerformCare 1-888-722-8646
TTY: 1-800-654-5984 or
PA Relay 711
1-888-700-7370
Welcome and Key Contacts – Chapter A
UPMC Health Plan www.upmchealthplan.com © 12-1-17 All rights reserved.
Pag
e34
Table A8: UPMC Community HealthChoices Contacts (Continued)
Contact Telephone Number
BH-MCO by Counties Member Services
Numbers
Provider Services
Numbers
Dauphin PerformCare 1-888-722-8646
TTY: 1-800-654-5984, or
PA Relay 711
1-888-700-7370
Delaware MBH 1-888-207-2911
TTY: 888-207-2910
1-800-686-1356
Elk CCBHO 1-866-878-6046
TTY: 1-877-877-3580
Spanish line:
1-866-229-3187
1-888-251-2224
Clinical fax:
1-866-294-3935
Erie CCBHO 1-855-224-1777
TTY: 1-877-877-3580
Spanish line:
1-866-229-3187
1-888-251-2224
Clinical fax:
1-855-892-8495
Fayette VBH 1-877-688-5972
TTY: 1-877-615-8502
1-877-615-8503
Forest CCBHO 1-866-878-6046
TTY: 1-877-877-3580
Spanish line:
1-866-229-3187
1-888-251-2224
Clinical fax:
1-866-294-3935
Franklin PerformCare 1-866-773-7917
TTY: 1-800-654-5984 or
PA Relay 711
1-888-700-7370
Fulton PerformCare 1-866-773-7917
TTY: 1-800-654-5984 or
PA Relay 711
1-866-773-7917
Fax: 1-888-296-4002
Fax: 717-671-6522
Greene VBH 1-877-688-5973
TTY: 1-877-615-8502
1-877-615-8503
Huntingdon CCBHO 1-866-878-6046
TTY: 1-877-877-3580
Spanish line:
1-866-229-3187
1-888-251-2224
Clinical fax:
1-866-294-3935
Indiana VBH 1-877-688-5969
TTY: 1-877-615-8502
1-877-615-8503
Welcome and Key Contacts – Chapter A
UPMC Health Plan www.upmchealthplan.com © 12-1-17 All rights reserved.
Pag
e35
Table A8: UPMC Community HealthChoices (Continued)
Contact Telephone Number
BH-MCO by Counties Member Services
Numbers
Provider Services
Numbers
Jefferson CCBHO 1-866-878-6046
TTY: 1-877-877-3580
Spanish line:
1-866-229-3187
1-888-251-2224
Clinical fax:
1-866-294-3935
Juniata CCBHO 1-866-878-6046
TTY: 1-877-877-3580
Spanish line:
1-866-229-3187
1-888-251-2224
Clinical fax:
1-866-562-2406
Lackawanna CCBHO 1-866-668-4696
TTY: 1-877-877-3580
Spanish line:
1-866-229-3187
1-888-251-2224
Clinical fax:
1-866-558-2618
Lancaster PerformCare 1-888-722-8646
TTY: 1-800-654-5984 or
PA Relay 711
1-888-700-7370
Lawrence VBH 1-877-688-5975
TTY: 1-877-615-8502
1-877-615-8503
Lebanon PerformCare 1-888-722-8646
TTY: 1-800-654-5984 or
PA Relay 711
1-888-700-7370
Lehigh MBH 1-866-238-2312
TTY: 1-866-238-2313
1-866-780-3368
1-866-542-0299
Luzerne CCBHO 1-866-668-4696
TTY: 1-877-877-3580
Spanish line:
1-866-229-3187
1-888-251-2224
Clinical fax:
1-866-558-2618
Lycoming CCBHO 1-855-520-9787
TTY: 1-877-877-3580
Spanish line:
1-866-229-3187
1-888-251-2224
Clinical fax:
1-855-345-0901
McKean CCBHO 1-866-878-6046
TTY: 1-877-877-3580
Spanish line:
1-866-229-3187
1-888-251-2224
Clinical fax:
1-866-294-3935
Mercer VBH 1-866-404-4561
TTY: 1-877-615-8502
1-877-615-8503
Welcome and Key Contacts – Chapter A
UPMC Health Plan www.upmchealthplan.com © 12-1-17 All rights reserved.
Pag
e36
Table A8: UPMC Community HealthChoices (Continued)
Contact Telephone Number
BH-MCO by Counties Member Services
Numbers
Provider Services
Numbers
Mifflin CCBHO 1-866-878-6046
TTY: 1-877-877-3580
Spanish line:
1-866-229-3187
1-888-251-2224
Clinical fax:
1-866-562-2406
Monroe CCBHO 1-866-473-5862
TTY: 1-877-877-3580
Spanish line:
1-866-229-3187
1-888-251-2224
Clinical fax:
1-866-652-2405
Montgomery MBH 1-877-769-9782
TTY: 877-769-9783
1-877-769-9779
Montour CCBHO 1-866-878-6046
TTY: 1-877-877-3580
Spanish line:
1-866-229-3187
1-888-251-2224
Clinical fax:
1-866-558-2618
Northampton MBH 1-866-238-2312
TTY: 1-866-238-2313
1-866-780-3368
1-866-542-0299
Northumberland CCBHO 1-866-878-6046
TTY: 1-877-877-3580
Spanish line:
1-866-229-3187
1-888-251-2224
Clinical fax:
1-866-558-2618
Perry PerformCare 1-888-722-8646
TTY: 1-800-654-5984 or
PA Relay 711
1-888-700-7370
Philadelphia CBH 1-888-545-2600
TTY: 1-888-436-7482
215-413-7660
Pike CCBHO 1-866-473-5862
TTY: 1-877-877-3580
Spanish line:
1-866-229-3187
1-888-251-2224
Clinical fax:
1-866-652-2405
Potter CCBHO 1-866-878-6046
TTY: 1-877-877-3580
Spanish line:
1-866-229-3187
1-888-251-2224
Clinical fax:
1-866-294-3935
Welcome and Key Contacts – Chapter A
UPMC Health Plan www.upmchealthplan.com © 12-1-17 All rights reserved.
Pag
e37
Table A8: UPMC Community HealthChoices (Continued)
Contact Telephone Number
BH-MCO by Counties Member Services
Numbers
Provider Services
Numbers
Schuylkill CCBHO 1-866-878-6046
TTY: 1-877-877-3580
Spanish line:
1-866-229-3187
1-888-251-2224
Clinical fax:
1-866-562-2406
Snyder CCBHO 1-866-878-6046
TTY: 1-877-877-3580
Spanish line:
1-866-229-3187
1-888-251-2224
Clinical fax:
1-866-558-2618
Sullivan CCBHO 1-866-878-6046
TTY: 1-877-877-3580
Spanish line:
1-866-229-3187
1-888-251-2224
Clinical fax:
1-866-558-2618
Susquehanna CCBHO 1-866-668-4696
TTY: 1-877-877-3580
Spanish line:
1-866-229-3187
1-888-251-2224
Clinical fax:
1-866-558-2618
Somerset PerformCare 1-866-773-7891
TTY: 1-800-654-5984 or
PA Relay 711
1-888-700-7370
Tioga CCBHO 1-866-878-6046
TTY: 1-877-877-3580
Spanish line:
1-866-229-3187
1-888-251-2224
Clinical fax:
1-866-558-2618
Union CCBHO 1-866-878-6046
TTY: 1-877-877-3580
Spanish line:
1-866-229-3187
1-888-251-2224
Clinical fax:
1-866-558-2618
Venango VBH 1-866-404-4561
TTY: 1-877-615-8502
1-877-615-8503
Warren CCBHO 1-866-878-6046
TTY: 1-877-877-3580
Spanish line:
1-866-229-3187
1-888-251-2224
Clinical fax:
1-866-294-3935
Washington VBH 1-877-688-5976
TTY: 1-877-615-8502
1-877-615-8503
Welcome and Key Contacts – Chapter A
UPMC Health Plan www.upmchealthplan.com © 12-1-17 All rights reserved.
Pag
e38
Table A8: UPMC Community HealthChoices Contacts (Continued)
Contact Telephone Number
BH-MCO by Counties Member Services
Numbers
Provider Services
Numbers
Wayne CCBHO 1-866-878-6046
TTY: 1-877-877-3580
Spanish line:
1-866-229-3187
1-888-251-2224
Clinical fax:
1-866-284-9184
Westmoreland VBH 1-877-688-5977
TTY: 1-877-615-8502
1-877-615-8503
Wyoming CCBHO 1-866-668-4696
TTY: 1-877-877-3580
Spanish line:
1-866-229-3187
1-888-251-2224
Clinical fax:
1-866-558-2618
York CCBHO 1-866-542-0299
TTY: 1-877-877-3580
Spanish line:
1-866-229-3187
1-888-251-2224
Clinical fax:
1-866-418-0366
Welcome and Key Contacts – Chapter A
UPMC Health Plan www.upmchealthplan.com © 12-1-17 All rights reserved.
Pag
e39
Table A8: UPMC Community HealthChoices Contacts (Continued)
Contact Telephone Number
Dental – Avesis
Provider Services 1-888-209-1243
Fax: 1-866-653-5544 (Secure)
Member Services 1-833-241-4245
TTY: 1-800-361-2629
Vision – Envolve
Member Services
Provider Services 1-866-838-7612
1-866-838-7612
TTY: 1-800-361-2629
Pharmacy Services 1-800-396-4139
Fax: 412-454-7722
Accredo Pharmacy
(mail order – for specialty medications
only)
1-888-853-5525
Community HealthChoices Hotline
PA Enrollment Support
1-800-440-3989
TTY: 1-800-618-4225
Pennsylvania Department of Human
Services (DHS)
General Information
Provider Hotline
Electronic Verification System
1-800-537-8862
1-833-735-4417
1-800-766-5387
Office of Medical Assistance (OMAP)
MA Provider Compliance Hotline
1-866-379-8477
Fax: 717-772-4655
TTY: 1-866-379-8477
DHS Adult Protective Services and
Older Adult Protective Services
Statewide Hotline: 1-800-490-8505
Disability Rights Pennsylvania 412-391-5225 (Pittsburgh Office)
215-238-8070 (Philadelphia Office)
717-236-8110 (Harrisburg Office)
Welcome and Key Contacts – Chapter A
UPMC Health Plan www.upmchealthplan.com © 12-1-17 All rights reserved.
Pag
e40
Table A8: UPMC Community HealthChoices Contacts (Continued)
Contact Telephone Number
Medical Management
(includes prior authorization and
concurrent review)
1-800-425-7800
Fax: 412-454-2057
Hours:
Monday through Friday, 8 a.m. to 4:30 p.m.
UPMC Community HealthChoices
Health Care Concierge Team 1-844-833-0523
TTY: 1-866-407-8762
Provider Network Management
(for notifying the Health Plan of
provider practice changes)
Fax: 412-454-5664
www.upmchealthplan.com/providers/change.html
Provider Services 1-844-860-9303
Hours:
Monday through Friday, 8 a.m. to 5 p.m.
Transportation Services UPMC
Medical Transportation
1-877-521-RIDE (7433)
UPMC Health Plan Web Services
(Web support)
1-800-937-0438
UPMC Health Plan Website www.upmchealthplan.com
www.upmchealthplan.com/chc (Community
HealthChoices site)
UPMC Disabilities Resource Center 412-605-1483
Renal Care
ESRD Care Managers 1-866-778-6073
UPMC Community HealthChoices
Fraud, Waste and Abuse
1-844-881-4143
Welcome and Key Contacts – Chapter A
UPMC Health Plan www.upmchealthplan.com © 12-1-17 All rights reserved.
Pag
e41
Table A8: UPMC Community HealthChoices Contacts (Continued)
Contact Telephone Number
Medical Assistance Transportation Program (MATP)
County Local Number Toll-Free Number
Adams 717-337-1345 1-800-830-6473
Allegheny 412-350-6100 1-888-547-6287
Armstrong 724-548-3408 1-800-468-7771
Beaver 724-375-2895 1-800-262-0343
Bedford 814-623-9129 1-800-323-9997
Berks 610-921-2361 1-800-383-2278
Blair 814-946-1235 1-800-245-3282
Bradford 570-888-7330 1-800-242-3484
Bucks 215-794-5554 1-888-795-0740
Butler 724-545-3669 1-866-638-0598
Cambria 814-536-9031 1-888-647-4814
Cameron 1-866-282-4968 1-866-282-4968
Carbon 570-669-6380 1-800-990-4287
Centre 814-355-6807
Chester 484-696-3854 1-877-873-8415
Clarion 814-226-7012 1-800-672-7116
Clearfield 814-765-1551 1-800-822-2610
Clinton 570-323-7575 1-800-206-3006
Columbia 1-800-632-9063 1-800-632-9063
Crawford 814-333-7090 1-800-210-6226
Cumberland 717-240-6340 1-800-315-2546
Dauphin 717-232-7009 1-800-309-8905
Delaware 610-490-3960 1-866-450-3766
Elk 1-866-282-4968 1-866-282-4968
Erie 814-455-3330 none
Fayette 724-628-7433 1-800-321-7433
Forest 814-927-8266 1-800-222-1706
Fulton 717-485-0931 1-888-329-2376
Franklin 717-264-5225 1-800-548-5600
Greene 724-627-6778 1-877-360-7433
Huntingdon 814-641-6408 1-800-817-3383
Indiana 724-463-3235 1-888-526-6060
Jefferson 814-938-3302 1-800-648-3381
Juniata 717-242-2277 1-800-348-2277
Welcome and Key Contacts – Chapter A
UPMC Health Plan www.upmchealthplan.com © 12-1-17 All rights reserved.
Pag
e42
Table A8: UPMC Community HealthChoices Contacts (Continued)
Contact Telephone Number
Medical Assistance Transportation Program (MATP)
County Local Number Toll-Free Number
Lackawanna 570-963-6482 None
Lancaster 717-291-1243 1-800-892-1122
Lawrence 724-652-5588 1-888-252-5104
Lebanon 717-273-9328 none
Lehigh 610-253-8333 1-888-253-8333
Luzerne 570-288-8420 1-800-679-4135
Lycoming 570-323-7575 1-800-222-2468
McKean 1-866-282-4968 1-866-282-4968
Mercer 724-662-6222 1-800-222-8797
Mifflin 717-242-2277 1-800-348-2277
Monroe 570-839-8210 1-888-955-6282
Montgomery 215-542-7433 none
Montour 1-800-632-9063 1-800-632-9063
Northampton 610-253-8333 1-888-253-8333
Northumberland 1-800-632-9063 1-800-632-9063
Perry 717-567-2490 1-877-800-7433
Philadelphia 1-877-835-7412 1-877-835-7412
Pike 570-296-3408 1-866-681-4947
Potter 814-544-7315 1-800-800-2560
Schuylkill 570-628-1425 1-888-656-0700
Snyder 1-800-632-9063 1-800-623-9063
Sullivan 570-888-7330 1-800-242-3484
Susquehanna 570-278-6140 1-866-278-9332
Somerset 814-445-9628 1-800-452-0241
Tioga 570-569-7330 1-800-242-3484
Union 1-800-632-9063 1-800-632-9063
Venango 814-432-9767 1-877-836-4699
Warren 814-723-1874 1-877-723-9456
Washington 724-223-8747 1-800-331-5058
Wayne 570-253-4280 1-800-662-0780
Westmoreland 724-832-2703
(Urgent care line for rides)
1-800-242-2706
Wyoming 570-278-6140 1-866-278-9332
York 717-845-7553 1-800-632-9063
Welcome and Key Contacts – Chapter A
UPMC Health Plan www.upmchealthplan.com © 12-1-17 All rights reserved.
Pag
e43
Closer Look at Community HealthChoices**
**The Community HealthChoices Program is the name of Pennsylvania's mandatory
managed care program for Medical Assistance with LTSS recipients and dual eligible
(Medicare and Medicaid) recipients.
The recipients have access to medical care and other appropriate physical health
services, whether the services are delivered on an inpatient or outpatient basis, through a
Managed Care Organization. Recipients evaluated to need nursing facility level of care
also have access to Long-Term Services and Supports (LTSS).
Recipients receive mental health and/or drug and alcohol services through Behavioral
Health Managed Care Organizations. This component is overseen by the Department of
Human Services’ Office of Mental Health and Substance Abuse Services.
UPMC Community HealthChoices is one of the Managed Care Organizations offered to
recipients in the following zones:
Southwest Zone
Beginning 1/1/18
Allegheny, Armstrong, Beaver, Bedford, Blair, Butler,
Cambria, Fayette, Green, Indiana, Lawrence, Somerset,
Washington, and Westmoreland counties
Southeast Zone
Beginning 1/1/19
Bucks, Chester, Delaware, Montgomery and
Philadelphia counties
Remainder of State
Beginning 1/1/20
Adams, 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
counties