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Preguntas Frecuentes

About Provider Enrollment Portal (PEP)

What is PEP? Why do I need to enroll if I’m already a provider with one of the MCOs (Vital) or MAOs (Platino Plans)? Why do I need to enroll in Medicaid PEP if I’m already enrolled in the ASES registry?

Deadlines

When do I need to enroll? What happens if I do not submit my enrollment by the deadline?

Enrollment

What are the documents that I need to submit to complete my enrollment? How do out-of-state (OOS) providers enroll? If I bill and render for my own services and render services for another group, do I have to enroll twice? How do I know if I need to enroll? Will I receive training to enroll in the PEP portal? If so, what methods are available?

Payment and Fees

Do I need to pay an application fee?

Enrollment in the Puerto Rico Medicaid Program (PRMP)

Additional questions regarding your enrollment in PRMP?




What is PEP?

The Puerto Rico Medicaid PEP is an online tool that allows providers, or their delegates, to submit an enrollment application for the Puerto Rico Medicaid Program (PRMP).

Why do I need to enroll if I’m already a provider with one of the MCOs (Vital) or MAOs (Platino Plans)?

Federal regulations 42 CFR 431.107 (b) and 455.410 (b) require that the State Medicaid Agency, the PRMP under the Puerto Rico Department of Health, to enroll providers participating in the Medicaid program, including all the providers that order, prescribe, refer, provide and bill services to the Government Health Plan (Vital and Platino Plans).

Why do I need to enroll in Medicaid PEP if I’m already enrolled in the ASES registry?

Federal regulations 42 CFR 431.107 (b) and 455.410 (b) require the State Medicaid Agency (PRMP) to enroll providers participating in Government Health Plan (Vital and Platino Plans). PRMP is implementing the direct enrollment of providers to meet these regulations. Once a provider is enrolled, the MCO/MAO may contract with the provider to be part of their network.

When do I need to enroll?

Enrollment will be conducted in waves, by provider enrollment types. Please see the wave schedule table for details.

What happens if I do not submit my enrollment by the deadline?

Providers who fail to enroll by the deadline will not be eligible to participate in the PRMP in any role, including billing, rendering, operating and OPR providers.

What are the documents that I need to submit to complete my enrollment?

Please refer to the checklist for your provider type for information and necessary documentation.

How do out-of-state (OOS) providers enroll?

OOS providers must submit an application through PEP and must include an OOS attestation form.

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 know if I need to enroll?

All providers who render, bill for, order, prescribe or refer services for Medicaid beneficiaries under the Government Health Plan (Vital or Medicare Platino) must enroll directly with the PRMP through the PEP. In summary, all providers who are required to be indicated on a claim/encounter must enroll to be eligible for federal funding. Please refer to the "Who Must Enroll" guidance document for more information.

Will I receive training to enroll in the PEP portal? If so, what methods are available?

PRMP will provide training through the following methods: reference guides, navigation guides, computer-based training (CBT), the Learning Management System (LMS), web-based training sessions, and in-person training sessions. To take self-paced courses and register for training sessions please go to the LMS portal which will be available early March 2020.

Do I need to pay an application fee?

As part of Federal Reg 42 CFR, Part 455.460, the application fee applies to "institutional" providers who are not already enrolled in Medicare or another state’s Medicaid program, or who have not paid an application fee to a Medicare contractor or to another state’s Medicaid program. The application fee does not apply to practitioners enrolling only as OPR providers. These providers are considered individual practitioners and are not subject to the fee, based on their provider type. Please refer to the application fee policy listed in the medicaid.pr.gov webpage in the section pertaining to the list of provider types that are subject to an application fee.

Additional questions regarding your enrollment in PRMP?

If you have questions regarding your enrollment in the Puerto Rico Medicaid Program (PRMP), please submit your inquiry by email to:
prmp-pep@salud.pr.gov.