Puerto Rico Provider Enrollment - Frequently Asked Questions
Why do I need to enroll if I am already a provider with one of the Vital Health MICOs or an MAO (Platinum Plans)?
Federal regulations 42 CFR 431.107(b) and 455.410(b) require the state Medicaid agency (the PRMP under the Puerto Rico Department of Health (PRDoH)) to enroll providers participating in the Medicaid program (including providers who order, prescribe, or refer for Medicaid services (Vital and Platino Plans)).
Each physical office address will need to register for a unique Medicaid ID – last two-digit suffix will represent each sequential location you register, for same Provider NPI/Tax ID.
If I bill and render for my own services and render services for another group, do I have to enroll twice?
Yes, you will need to enroll as an “individual” for your sole proprietor location and as an “individual within a group” for services you provide through the group.
How do I enroll?
April 27, 2020, the Puerto Rico Medicaid Program (PRMP) implemented the Medicaid enrollment process via the Provider Enrollment Portal (PEP) https://medicaid.pr.gov/Home/PEP .
What information do I need?
Physical address of each location you intend to perform services. Each location will need to register for a unique Medicaid ID. There are separate checklists for Optometrist, Group of Optometrists and Durable Medical Equipment (Optical Hardware) – Please review the correct list for your provider type.
Checklists provide the type of information and documentation needed to complete an application according to your vendor type. To access your provider type checklists check the PEP page on the Medicaid website at https://medicaid.pr.gov/Home/PEPChecklist/ .
How long do I have to complete my application once I start?
Your incomplete application will expire after 30 days without activity. If it expires, you must start a new one. The PEP will constantly generate notices to remind you to complete and submit your application.
As a reminder, the PEP will email you important notifications that may require your immediate attention as they may have due dates. Please ensure that you check your spam/junk folder and mark PRMP-PEP@salud.pr.gov as a safe sender. If you are not receiving email from this address and do not find them in your spam/junk folder, please contact your administration to research the issue.
Who should I contact with further questions?
If you have any questions regarding this communication, please contact the EMPR/Envolve Vision Provider Participation team immediately by calling 1-800-531-2818. Our EMPR/Envolve team is available to address any of your questions and concerns.