The Provider Enrollment Portal (PEP) is an online tool that allows providers, or their delegates, to submit an enrollment application for the Puerto Rico Medicaid Program (PRMP).
Federal Regulation 42 CFR 431.107 (b) and 455.410 (b) require that the State Medicaid Agency - the Puerto Rico Medicaid Program (PRMP), under the Puerto Rico Department of Health (PRDoH), enroll and screen all providers participating in the Medicaid Program. This includes providers that order, prescribe, refer, provide, or bill for services for Medicaid beneficiaries to the Medicaid Program (Vital and Medicare Advantage Plans).
All providers that order, prescribe, refer, provide, or bill services for Medicaid beneficiaries under the Government Health Plan (Vital or Medicare Platino) must enroll directly with the Puerto Rico Medicaid Program (PRMP) through the Provider Enrollment Portal (PEP), including all service locations addresses at which services are rendered to Medicaid beneficiaries. 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 with PRMP" guidance document for more information.
Yes, you will need to enroll as an “Individual” enrollment type for your sole proprietor location and as an “Individual within a group” enrollment type for the services you provide through the group.
All service locations at which services are rendered to Medicaid beneficiaries needs to be enrolled. Only the following provider types are permitted to enroll multiple locations under a single application. They are:
The individual physician needs to enroll with an enrollment type of “Individual within a group” and must associate this enrollment to the PMG. If the individual physician also performs and bills for services independently outside of the PMG, an additional application will need to be submitted for all service locations at which services are rendered to Medicaid beneficiaries with an enrollment type of “Individual.” The PMG should not be associated with the “individual” enrollment.
Corporations will select either a “Group or Clinic” or a “Facility” enrollment type, depending on their provider type. Please refer to the checklist for your provider type for more information.
Sole proprietors must use the enrollment type of “Individual or Sole Proprietor” along with the appropriate provider type. If you do not see your provider type listed as available for an “Individual or Sole Proprietor,” please contact PRMP at PRMP-PEP@Salud.pr.gov. If you are a sole proprietor, you must have a type 1 (individual type) National Provider Identifier (NPI) and your NPI must be designated with the National Plan and Provider Enumeration System (NPPES) as a sole proprietor.
Out-of-State (OOS) providers must submit an application through the PEP and must include an OOS emergency or prior authorization attestation form, which is available on the PEP forms section of Medicaid website. If the OOS provider has a contract with a Managed Care Organization (MCO) as a “Border status” provider, the OOS provider must attach a copy of the contract.
The acronym MCO stands for Managed Care Organization. MCOs are healthcare provider organizations that provide medical services in a managed care arrangement. The Puerto Rico Medicaid Program (PRMP) contracts with MCOs to provide care for its Medicaid members.
Training is available through the following methods: reference guides, navigation guides, and computer-based training (CBT) all of which are available in the Learning Management System (LMS) at https://lms.prmmis.pr.gov/
No, an LMS certificate is not needed or used in entering a provider application.
No, the LMS is an educational tool that will help providers learn how to use the PEP to submit their application. It is recommended that providers review the training materials in the LMS before they attempt to submit their application in PEP, but it is not required.
As part of Federal Regulation 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. Please refer to the application fee policy listed in the policy section of the Medicaid website at https://www.medicaid.pr.gov/Home/PEPPoliticas/.
The application fee is established by the Centers for Medicare and Medicaid Services (CMS), and generally changes annually. Below is a list of the most recent fees by calendar year:
| Calendar Year | Application Fee |
|---|---|
| 2024 | $709.00 |
| 2023 | $688.00 |
| 2022 | $631.00 |
| 2021 | $599.00 |
| 2020 | $595.00 |
A bank manager’s check (cashier’s check) or money order is required to pay the fee. Please refer to the Provider Application Fee Instructions available at here.
The Puerto Rico Medicaid Management Information System (PRMMIS) uses the Taxonomy and zip +4 code to locate the correct Medicaid ID to assign to the encounter for processing. All service locations at which services are rendered to Medicaid beneficiaries needs to be enrolled. This is important when providers have multiple enrollments / service locations.
Providers enrolling and revalidating with PRMP are required to consent to enrollment and screening regulations with the Puerto Rico Fingerprint-based Criminal Background Check policy when is it determined that providers pose an increased risk of fraud, waste or abuse to the Medicaid program. High-risk provider types are:
All owners of high-risk providers with 5% or more interest as well as all managing employees/agents of the Medicaid provider are required to consent to the fingerprint based criminal background check upon request from the Centers for Medicare and Medicaid Services (CMS) or the Puerto Rico Medicaid Program.
The Puerto Rico Medicaid Program (PRMP) will rely on a federal fingerprint-based background check from Medicare’s screening when the provider is enrolled with Medicare and has been screened within the past 5 years (regardless of whether the provider is located in-state or out of state). PRMP will rely on a federal fingerprint-based background check from another State Medicaid’s screening for an out-of-state provider when the provider has been screened within the past 5 years. Screenings from Medicare and other State Medicaid programs must be verified through PECOS for Medicare and with the other State Agency for Medicaid.
Your unsubmitted application will expire after 30 days of no activity. If it expires, you must start over. The Provider Enrollment Portal (PEP) will generate email notices to remind you to complete and submit your application.
Checklists provide the type of information and documentation required to complete an application according to your provider type. Please refer to the PEP page on the Medicaid website located at https://www.medicaid.pr.gov/Home/PEPChecklist/ to access the checklists.
Supported internet browsers include, Microsoft Internet Explorer (version 7.0 and later), Google Chrome (version 70.0.3538 and later), Microsoft Edge (version 41.16299.15 and later), and Mozilla Firefox (version 2.0 and later).
Once the enrollment application is submitted, you can verify the status of your enrollment application by accessing the PEP home page. From the “Provider Enrollment” dropdown, select “Enrollment Status.” Once the “Enrollment Status” credentials page displays, enter in the indicated fields your enrollment application tracking number and the password created during your enrollment registration. Click on "Generate Authentication Code" and an authentication code will be sent to the email registered for the corresponding application. Once you have received the authentication code, enter it in the field and click "Submit."
The length of time it takes to process an application varies, depending upon whether the application was received with all the valid and required documentation or if the application had to be returned for corrections or additional information. You may check the status of your application at any time by going to the Provider Enrollment Portal (PEP) home page.
Required attachments for your provider type and specialty are displayed in the “Required Attachments” section of your application. The “Requirement Met” column displays “No” if the attachment has not been added. Click “Create New” at the top-right of the “Attachment Details” panel to add a new attachment. Complete all the required fields in the pop-up window and upload the document. In the “Required Attachments” panel, the “Requirement Met” column of an attachment changes from “No” to “Yes” once the attachment has been added. Click “Save and Continue” at the bottom-right to ensure all attachments are saved.
File formats currently accepted as attachments include: .xlsx, .xls, .docx, .doc, .png, .txt, .jpg, .pdf, .gif, and .zip.
In the “Agreement/Submit” step in the Provider Enrollment Portal (PEP), navigate to the bottom of the page in the “Form” section, and the Provider Agreement document will be displayed. To download, click on the download icon (arrow pointing down) located in the upper-right hand corner of the document header.
The tax classification should be the same as the one listed on your W-9 form and should be consistent with your type of National Provider Identifier (NPI).
You can change the language displayed on the PEP welcome screen by clicking the dropdown menu on the upper-right side of the home page. This will allow you to change the language to Spanish from the default language, English. You can only change the language on the home page before you select the menu dropdown to start your application.
If you have the language on the PEP home page set to English when you start your application, you must use the English MM/DD/YYYY format. If you have language on the PEP home page set to Spanish when you start your application, you must use the Spanish DD/MM/YYYY format. Use the calendar on the right side of the field to avoid formatting errors in that field.
The “Effective Date” is the date you wish the enrollment in PRMP to become effective once approved. Providers may request a backdated effective date up to 90 days, as long as they meet all enrollment criteria during that time period.
The “Mail-to Address” refers to the address at which you can receive any regular mail. The “Pay-to Address” refers to the address at which the provider receives payments for the provision of healthcare services, equipment, or supplies. Both addresses are shared with the Managed Care Organizations (MCOs).
Negative Certificates of Penal Record must be no older than 30 days, calculated between the date of issuance of the Certificate of Penal Record and the date the application was submitted.
Verification codes expire after 10 minutes. Once expired you must request a new code.
The W-9 is an Internal Revenue Service (IRS) form. The Puerto Rico Medicaid Program (PRMP) uses the IRS W-9 form to collect the correct taxpayer identification number from providers during the enrollment process. The W-9 form is available on the IRS website at https://www.irs.gov/pub/irs-pdf/fw9.pdf .
First, check to see if it’s in your email’s junk or spam mailbox. If the message is there mark PRMP-PEP@salud.pr.gov as a safe sender, so future communications arrive directly to your inbox. If the email is not in your junk mail, check with your administrator to see if there is a firewall that could be blocking the email.
If your CLIA Certificate Type states "Certificate of Compliance,” select “Regular.” If it states “Certificate of Waiver," select "Waiver." If it states "Certificate of Accreditation," select "Accreditation." If it states "Certificate of PPMP," select "Provider - Performed Microscopy Procedure (PPMP).” If it states "Certificate of Registration," select "Registration."
The email address for the person who is responsible for completing the provider's application should be entered in the registration email panel.
This is intended to understand the approximate maximum of Medicaid patients you can serve.
Providers enrolled with Medicare may enter in the Medicare number field either their legacy Medicare ID, their Provider Transaction Access Number (PTAN), or their National Provider Identifier (NPI).
Once the enrollment request is submitted, you can print and check the status of your enrollment request through the Provider Enrollment Portal (PEP) by accessing the PEP home page. From the "Provider Enrollment" drop-down menu, select "Enrollment Status." The "Enrollment Status" credential page will appear. Enter the tracking number of your enrollment request and the password created during your enrollment registration in the fields provided. Click "Generate Authentication Code." An authentication code will be sent to the email registered for that enrollment request. Once you have received the authentication code, enter it in the field and click “Submit.” On the Enrollment Status page, click the "Print" tab on the upper right corner. The print preview window will open. In the print preview window, check the information for the enrollment steps you would like to print. If you check "Select All," the entire application will be printed once you click the "Print" button at the bottom right.
When the user starts a new enrollment application with an incorrect registration email address and exits out the application without submitting it, they will need to begin a new application and register with a correct email address. The previous application will expire after a time period of inactivity.
The Centers for Medicare & Medicaid Services (CMS) requires prescribing providers noted on a claim to be enrolled with the Puerto Rico Medicaid Program. Pharmacists can now enroll with an enrollment type of Ordering, Prescribing, or Referring (OPR), a Provider Type of B1- Pharmacist, and a Specialty of 128-Pharmacist. Refer to the Pharmacist enrollment checklist https://medicaid.pr.gov/pdf/PEP-Checklist/Provider%20Type%20B1%20Pharmacist%20Checklist.pdf, for enrollment requirements.
Pharmacy - provider type 20- should only be used by billing pharmacies/facilities that dispense medicinal drugs. Pharmacist - provider type B1 - is an individual who is the Ordering/Prescribing/Referring (OPR) provider.
No. Pharmacists are enrolled as the Ordering/Prescribing/Referring providers. The entity billing for services provided by a pharmacist will list the pharmacist as a prescribing provider on the claim.
Providers can reference the Taxonomy code list below:
| Code | Grouping Classification | Specialization | |
|---|---|---|---|
| 183500000X | Pharmacy Service Providers | Pharmacist | |
| 1835P2201X | Pharmacy Service Providers | Pharmacist | Ambulatory Care |
| 1835C0206X | Pharmacy Service Providers | Pharmacist | Cardiology |
| 1835C0207X | Pharmacy Service Providers | Pharmacist | Compounded Sterile Preparations |
| 1835C0205X | Pharmacy Service Providers | Pharmacist | Critical Care |
| 1835E0208X | Pharmacy Service Providers | Pharmacist | Emergency Medicine |
| 1835G0303X | Pharmacy Service Providers | Pharmacist | Geriatric |
| 1835I0206X | Pharmacy Service Providers | Pharmacist | Infectious Diseases |
| 1835N0905X | Pharmacy Service Providers | Pharmacist | Nuclear |
| 1835N1003X | Pharmacy Service Providers | Pharmacist | Nutrition Support |
| 1835X0200X | Pharmacy Service Providers | Pharmacist | Oncology |
| 1835P0200X | Pharmacy Service Providers | Pharmacist | Pediatrics |
| 1835P0018X | Pharmacy Service Providers | Pharmacist | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
| 1835P1200X | Pharmacy Service Providers | Pharmacist | Pharmacotherapy |
| 1835P1300X | Pharmacy Service Providers | Pharmacist | Psychiatric |
| 1835S0206X | Pharmacy Service Providers | Pharmacist | Solid Organ Transplant |
The PEP collects provider associations. Associations define the business relationship between a group provider and its rendering provider members or associates. A medical group is a collection of doctors who have partnered with one another, contractually, to share the care of patients. A group association within PEP defines this relationship so that the group can bill for the services rendered by its group members. PEP also collects information about ownership, which is separate from the associations defined above. The associations that PEP collects should not be confused with affiliations that the MCOs collect. Affiliations define the relationships among providers and Managed Care Organizations (MCOs) Vital or Medicare Advantage Organizations (MAOs) and their benefit plans. Affiliations are based on contractual network relationships and not the business relationship between various providers. For instance, a Primary Medical Group (PMG) allows physicians who aren’t one combined corporate entity to enjoy the benefits of a larger organization in serving the needs of a health plan. These affiliations are defined by the health plan and represent the relationship of each provider to the health plan, its type of relationship (PMG, preferred network, general network, not contracted), and the relationships between the providers (Primary Care Provider (PCP) to PMG, preferred network to PMG), as applicable.
In order for an “Individual Within a Group” (IG) to associate to a group during their PEP application process, the group to which they are associating must already be enrolled. In order for a group to associate IGs during their PEP application process, the IGs must already be enrolled. The National Provider Identifier (NPI) and Medicaid ID is needed to make the association. At any time, if the group and IG are already enrolled, either one can initiate a group association via the provider change request form available on the Medicaid website.
A physician who is associated to multiple groups needs one application as enrollment type “Individual Within a Group” (IG). This application should be associated to every group in which the provider is a member. Physicians who also practice independently outside of the group(s) must also enroll all service locations at which services are rendered to Medicaid beneficiaries as an “Individual” enrollment type.
The group should share their National Provider Identifier (NPI) and Medicaid ID with their associated individuals. Individuals within a group (IGs) should share their NPI and Medicaid ID with their groups. The request can be made from either entity.
No. The associations in PEP define the business relation between a provider group and its rendering member or associates. This enables the group to bill for the services rendered by the individuals within the group. The contractual relationships maintained by the MCOs define the affiliations that are based on the network within the MCO, such as preferred network or general network.
According to Federal Regulation 42 CFR 455.101 subcontractor is defined as: (a) An individual, agency, or organization to which a disclosing entity has contracted or delegated some of its management functions or responsibilities of providing medical care to its patients; or (b) An individual, agency, or organization with which a fiscal agent has entered into a contract, agreement, purchase order, or lease (or leases of real property) to obtain space, supplies, equipment, or services provided under the Medicaid agreement.
Examples include, but are not limited to the following:
A surety bond is defined as a three-party agreement that legally binds together a principal who needs the bond, an obligee who requires the bond, and a surety company that sells the bond. The bond guarantees the principal will act in accordance with certain laws. If the principal fails to perform in this manner, the bond will cover resulting damages or losses. Per Federal Regulation 441.16, the Puerto Rico Medicaid Program (PRMP) requires Home Health Agencies (HHAs) to obtain a surety bond for the greater of either $50,000 or 15 percent of the annual Medicaid payments made to the HHA by the Medicaid agency. The bond must list the Puerto Rico Medicaid Program as the obligee. Federal funding is prohibited to HHAs who do not have a valid surety bond. Failure to provide an updated bond will result in termination and recoupment of any funds paid during the time period that a bond is not in effect.
It’s a postponement which allows the Puerto Rico Medicaid Program (PRMP) to temporarily waive the application fee and background checks, during the time that COVID-19 is a declared national emergency. The PRMP will lift this waiver effective April 3rd, 2023.
The Puerto Rico Medicaid Program (PRMP) will lift application fee and fingerprint based criminal background check waivers effective 04/03/2023. Providers who received an application fee waiver will receive a notification to the mail-to email address on file with instructions for submitting the application fee. Owners and managing employees, who received a background check waiver will receive notification to the owner/managing employee email on file, with instructions for completing the background check.
In accordance with Federal Regulation 42 CFR 455.432, the Puerto Rico Medicaid Program (PRMP) is required to conduct site visits for provider types who are designated as moderate or high risk.
The purpose of the site visit will be to verify that the information submitted to the PRMP is accurate, and to determine compliance with federal and state enrollment requirements. The scope of the visit is to review physical facility information, OSHA and other safety information, facility appearance (inside and outside), records and confidentiality, and office and appointment availability information. The field representative will review the facility, ask questions, and may request supporting documentation to complete their site visit.
The providers designated as moderate or high risk are:
Once your application via the Provider Enrollment Portal (PEP) has been approved, you can register for PSC. Click on “Register” which is located on the top right of the webpage. To create a new account, you will need your approved Application Tracking Number (ATN) and either your National Provider Identifier (NPI) or Tax ID. Enter and confirm a valid email address and click on “I'm not a robot.” When you click on “Register” you will be asked to confirm your email by clicking on a link sent to your email. Once confirmed, you will be able to login with your credentials.
File formats currently accepted as attachments include: xlsx, .xls, .docx, .doc, .png, .txt, .jpg, and pdf.
Supported internet browsers include: Microsoft Internet Explorer (version 7.0 and later), Google Chrome (version 70.0.3538 and later), Microsoft Edge (version 41.16299.15 and later), and Mozilla Firefox (version 2.0 and later).
The welcome letter informs you that your application for participation in the Puerto Rico Medicaid Program (PRMP) has been approved according to the Provider Agreement. To obtain this letter, you must register in Provider Secure Communications (PSC). Once you register with PSC, your welcome letter to your approved Medicaid enrollment application will be the first secure message in your PSC account. To access the Provider Welcome Letter, log into your PSC account and click “Messages.” The welcome letter will be displayed here 1-2 business days after receiving the Application Tracking Number (ATN) approval notification. Click the “Details” button to view and download the Provider Welcome Letter, available in English and Spanish.
Providers are required to notify the Puerto Rico Medicaid Program (PRMP) within 30 days of any changes in enrollment information. Failure to comply with the requirements to report changes to the provider’s Medicaid enrollment information could result in the termination of the Provider Agreement. Certain changes must be made via the Provider Information Change Request Form with the provider’s or managing employee’s signature. Some changes require a new application. Please refer to the Provider Information Change Request Form on the Medicaid website for the details. The form is available for download at https://www.medicaid.pr.gov/Home/PEPForms/ . Once the fields related to the desired changes have been completed and the document has been signed and dated, log into the Provider Secure Communications (PSC) portal. Click the “Documents” tab, then click “Create New.” Follow the instructions on the screen, and when finished, click “Create.” You will receive a confirmation of receipt of your request from PRMP by email within 1-3 business days.
Checklists provide the type of information and documentation required to complete an application according to your provider type. Please refer to the PEP page on the Medicaid website located at https://medicaid.pr.gov/Home/PEPChecklist/ to access the checklists.
Navigate to the login page on the PSC Portal website at https://psc.prmmis.pr.gov/. Click the “Forgot Password” link at the bottom of the sign on page and follow the prompts to reset your password.
If you do not know the email that was originally used to create the PSC account, call the contact center at (787) 641-4200 Monday through Friday from 8:00 a.m. to 5:00 p.m.
Your ATN was generated when you completed your enrollment application in PEP. Check the emails that you used to create your enrollment application to find your ATN. The ATN is included in your PEP registration email and password reset email(s). If you cannot locate your ATN, call the contact center at (787) 641-4200 Monday through Friday from 8:00 a.m. to 5:00 p.m.
The Provider Agreement was updated to align with recent changes to the Provider Revalidation Policy. The update extends the current 3-year revalidation timeframe to 5 years for physicians. All other non-physicians with an enrollment effective date prior to 12/31/2022, will be extended to 4 years. Non-physicians with an enrollment effective date on or after 1/1/2023, will remain at 3 years. The updated Agreement must be formally acknowledged through the Provider Secure Correspondence (PSC) Portal.
Providers will receive a series of notifications that will provide important information on the updates being made to the Provider Agreement and the requirement to acknowledge the updated Agreement through the PSC Portal. Email notifications will be sent to your Mail-To email address on file. Please ensure that your Mail-To email address associated to your Medicaid ID is accurate.
To view and/or update your Mail-To email address, log in to the PSC Portal website at https://psc.prmmis.pr.gov/ and click on the “Demographics” link at the top of the page. A list of addresses associated to your service locations will display. From there you can view or edit your Mail-To email address. To update your information, click the “edit” link next to the email address that needs to be updated. Note that Mail-To email addresses are specific to each service location.
Notifications will be sent to the Mail-To email addresses on file, according to the schedule below.
Yes, all providers will be required to formally acknowledge the updated Provider Agreement to continue your Medicaid Enrollment. For more information on how to access PSC to view your updated agreement, refer to the PSC FAQs on this page.
To acknowledge the updated Provider Agreement, log into your PSC account at https://psc.prmmis.pr.gov/, and navigate to the “Acknowledgement” link at the top of the page. Review each Service Location associated to the registered Mail-To email address then navigate to the bottom of the page. Click the check box message “Example”: By clicking the submit button, I acknowledge that I have read and accept the terms and conditions set within the updated Provider Agreement for all the service locations listed above”. Lastly, click the “Submit” button. This will register your acknowledgement.
Updated Provider Agreements must be acknowledged in PSC using the Mail-To email address on file. To ensure you have the proper access to PSC with your Mail-To email address, review the scenarios below to determine which one best applies to you:
Once the user clicks submit, PSC will display a message alerting the user that acknowledgement of the new Agreement will extend their Medicaid Agreement End Date.
No, the submit button will be disabled after the provider has acknowledged in PSC.
Users must authorize and acknowledge each service location during the acknowledgement process. If one or more of the service locations listed on the screen are no longer active, a voluntary termination request must be submitted through the Provider Information Change Request process. Change request forms can be obtained on the Forms page of the Medicaid website here.
Yes, providers will be able to print the Provider Agreement before and after the acknowledgement.
Active providers will receive Revalidation reminder letters stating they can complete their revalidation enrollment with instructions on how to do so, starting 90-days prior to the end date of their Medicaid agreement. Subsequent reminders will be sent 60 and 30-days prior to the end date of their Medicaid agreement. This means that providers can begin their revalidation process as soon as they receive the first Revalidation reminder.
Active providers who acknowledged the updated Provider Agreement through the Provider Secured Communication account (PSC) had their Medicaid agreement end date extended based on the terms noted in section 2.7 of the updated Provider Agreement with the Puerto Rico Medicaid Program (PRMP). For providers who completed their initial enrollment on or before 12/31/2022 the following statements apply:
The Puerto Rico Medicaid Program (PRMP) will send notifications to the provider’s “Mail-to” email address listed in their record. The provider will be referred to their Provider Secured Communication account (PSC) where they can access the revalidation reminder notification under the Messages Tab.
Providers can find their initial enrollment Application Tracking Number (ATN) in their welcome letter located in the Provider Secured Communication tool (PSC) under the messages tab. However, the Revalidation Reminder notification will provide a new ATN for revalidation with a temporary password to access the revalidation enrollment in the Provider Enrollment Portal (PEP).
To start your revalidation enrollment in the Provider Enrollment Portal (PEP), navigate to the Resume/Revalidate Enrollment option from the Menu/Provider Enrollment dropdown. It is imperative to follow the instructions in the Revalidation Reminder notification given that the letter will provide you with a new Application Tracking Number (ATN) for revalidation and a temporary password that will need to be changed to begin your revalidation enrollment.
The difference is that a re-enrollment occurs when a provider has been terminated by the Medicaid Program and is completing a new enrollment application. Whereas revalidation is the process of validating the data entered on the initial application. The revalidation process begins 90 days before the Medicaid Agreement expires between the Puerto Rico Medicaid Program and the provider.
No, all active associations provided at the time of initial enrollment and any additional associations that have been requested post-enrollment through the change request form will be reflected in the Associations step of the revalidation application for Groups and Individuals whining Groups. Note that all association end dates will be defaulted to 12/31/2299. Providers will have the opportunity to make any updates to their active associations by adding or deleting associations. If a new association is required during the revalidation process, the provider can add the association with their active Medicaid ID.
According to policy PRMMIS – PRV-0002 Provider Revalidation and per federal regulation 42 CFR 455.414, providers are required to revalidate their provider information periodically. Medicaid funds can only be used for covered healthcare services rendered by an individual or entity who has a provider agreement in effect with the Puerto Rico Medicaid Program (PRMP).
If a provider fails to complete the revalidation process before the agreement end date on record, the provider's Medicaid ID will be terminated. Once the provider’s record has been terminated, the provider must submit a new enrollment to re-establish their enrollment in the Puerto Rico Medicaid Program (PRMP).
The application fee that was paid in 2023 covered the initial enrollment application fee which was waived due to the Public Health Emergency of COVID-19. Provider types that require an Application Fee will also need to submit a payment for revalidation unless the applicable application fee has been paid to the Centers for Medicare and Medicaid (CMS) or to another State as noted in 42 CFR 455.460(a)(2)(iii). See the PRMMIS-PRV-0005 Provider Application Fee policy for a complete list of provider types required to pay the application fee.
Providers who enrolled multiple service locations under one enrollment application, must revalidate the information for each service location under separate revalidation applications. A unique revalidation Application Tracking Number (ATN) will be generated for each service location and provided in the revalidation reminder notifications.
No, providers are not able to edit the legal name, Tax ID or the National Provider Identifier (NPI) in the revalidation application. In this scenario, the provider will be required to complete the termination section within the change request form and submit it through the Provider Secure Communication (PSC). A new application will be needed to provide the new information.
The Return to Provider (RTP) Notifications will be sent to the provider’s mail-to email address. The RTP notifications will include a description of the missing information. It is important to address all RTP Reasons in this letter to be able to complete the revalidation process as soon as possible.
Yes, all the providers that successfully complete the revalidation process will receive a Revalidation Successful Letter that will be available in the message section of the Provider Secure Communication Tool (PSC). The Revalidation Successful Letter shows the new end date of the contract between the provider and the Puerto Rico Medicaid Program (PRMP).
No, providers are encouraged to check their revalidation status before resuming their revalidation in the Provider Enrollment Portal (PEP). Providers who have been terminated/expired must submit a new enrollment application.
Yes, the Puerto Rico Medicaid Program (PRMP) must conduct a Site Visit on all revalidation applications for active providers deemed as “Moderate” risk during Revalidation unless the Puerto Rico Medicaid Program (PRMP) can waive the Site Visit due to their Medicare enrollment. This is to comply with the PRMP Site Visit Policy PRV-0008 and as per CFR 455.432. The Puerto Rico Medicaid Program (PRMP) may rely on the provider’s site visit screening results performed by Medicare when applicable.
During the revalidation process, your Provider Secure Communication (PSC) account will be locked, which will prohibit you from uploading change requests via the Provider Secure Communication (PSC). All changes must be made through the revalidation application.
The delegate must contact the Provider Secure Communication (PSC) account owner to ensure that all necessary privileges related to the message section are assigned to that specific delegate. As a reminder, the delegate authorization needs to be revalidated yearly.
During the revalidation process the system allows the provider to update the service location. The provider can edit/delete the current service location or add a new one. If the provider enters a new service location in the revalidation application, the provider must enter a valid physical address and include the zip+4.
Yes, the revalidation application process allows for changes in ownership. The entire disclosure section of the revalidation application (including each disclosure tab) will need to be completed. For providers enrolled in Medicare, note that ownership information provided to the Puerto Rico Medicaid Program (PRMP) must align with ownership information reported in the Medicare Provider Enrollment, Chain, and Ownership System (PECOS).
Only fields that are not disabled or read-only can be modified as part of the revalidation process. If modifications to other fields are required, contact customer service for further assistance.