• How do I know if I need to enroll?

  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.

• Why do I need to enroll if I’m already a provider with one of the Managed Care Organizations (MCOs) Vital or Medicare Advantage Organizations (MAOs)?

  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).

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