- Participant Providers Contracting Issues
- Recredentialization Process
- Claims Issues
- Financial Issues
- Services with Prior-Authorizations
Request Contract Changes, Access the form and send it
Access here
Need a copy of your Provider Contract
Access hereRequest information about your Re-credentialization process
The OCS Digital Credentialing Platform implementation begins, starting September 25, 2023.
In this first phase, Individual and Incorporated individual health providers will be able to begin creating their accounts and make their required data and documents accessible, to execute the credentialing process with the insurers, which they authorize on the OCS Digital Credentialing Platform.
Discuss claim matters
For matters related to claims and services in general, you can now access the new TurnosPR system through this link: https://sss.turnospr.com. It offers you the alternative of coordinating your appointments in person or by video call through the Teams tool.
Important: The system will allow you to coordinate a face-to-face appointment or video call for 3 NPIs; If you represent more than 3 providers, you should contact the provider service department (Professional Relations) at 787-749-4949 ext. 8323113 or write to moc.r1732180993psss@1732180993selan1732180993oisef1732180993orpse1732180993noica1732180993ler1732180993
On the day of your appointment, you must present:
- Authorization letter from the supplier if you are representing the supplier, group, or corporation. To access the form, please go to the following link: PDF form
- Copy of:
- Adjustments and/or claims to be discussed with the inclusion of the adjustment sheet
- EOP (if applicable)
- Referral (if applicable)
- Pre-authorization (if applicable)
- All documentation that is required according to the service offered:
- Using the adjustment sheet according to the line of business
- Group claims by situation and line of business
Get an explanation of payment
If you are a NON PAR provider or you are not registered in My Triple-S, find here your Explanation of Payment (EOP)
Access hereIf you are registered in My Triple-S, you can find you Explanation of Payment (EOP)
Access here
Request payment history
Access here
Submit Decrees/Releases to Finance
Access here
Payment
Access here
Request a Check Investigation
Access here
How to Request a Service Prior-Authorization
Access here
Request payment history
To request a payment history, you must complete the attached form and then include it using the "Add File" button. Finally, select “Send Document” so that we can receive and process it.
Payment
We want to offer you a more agile payment process and faster access to the funds.
That's why, Triple-S began a transition in our payment methodology, from payment by check to payment through direct deposit or ACH.
If you have not yet completed the enrollment form for the direct payment or ACH you must immediately send us the necessary bank information to proceed with your registration to our new payment methodology.
IMPORTANT: the request must be accompanied by a voided check to proceed with the change.
You may send the completed enrollment form and voided check by:
- Mail: Professionals Relations PO Box 363628 San Juan PR 00936
- Fax: (787) 749-4190
- Personally, at one of our Service Centers
- Using our digital mail sending option below:
Request a Check Research
To request the investigation of a check, you must complete the attached form and then include it using the "Add File" button. Finally, select "Send Document" so that we can receive and evaluate it.
Dear Participating Provider
If you need to make any changes to your contract, you must complete the attached form and then include it using the "Include Document" button and submit it so that we can receive and evaluate it.
The types of changes that you can request are demographic changes, adding a line of business or specialty, group inclusions, changing from individual to corporation, adding location, adding services, among others.
You need a copy of your Provider contract
To request a copy of your provider contract, you must complete the attached form and then include it using the "Add File" button. Finally, select “Send Document” so that we can receive and process it.
Submit Decrees/Releases to Finance
Basic requirements
- Annual Affidavit or
- Release issued by the Department of the Treasury
Requirements for Modifications:
If you do not have a decree, you must provide a copy of the relief issued by the Department of the Treasury.
If the decree is sent, it must be accompanied by an affidavit (the decree alone is not accepted). It is important that the Affidavit refer to the decree number and the taxable year to which it applies.
Triple-S Salud (TSS) is an independent licensee of the BlueCross BlueShield Association (BCBSA) for Puerto Rico and the U.S. Virgin Islands. BlueCard® Program (BCP) is a national program that allows the members of Blue Plans to obtain health services while traveling or living in different Blue Plan service areas.
As a Triple-S Salud participating provider, you are required to provide services to patients covered by a National Account of another Blue Plan who are traveling or reside in Puerto Rico.
Provider's Responsibility to the BlueCard® Program:
- As a Triple-S Salud Network participating provider, you are required to provide services to patients covered by a National Account of another Blue Plan who are traveling or reside in Puerto Rico.
- Update your Provider information. Keeping our Provider information up to date is of vital importance to guarantee that our members have adequate access. Updating the information helps us maintain a more accurate and accessible Provider Directory for our members.
- Since each provider is responsible for informing the Plans of any changes, we remind our Providers to notify Triple-S Salud of any changes in their demographic data or other important information, such as changes in their ability to accept new patients, street address, phone number, or any other change affecting patients' access to care.
For more information, you may contact our Customer Service Department through our Call Center at (787) 749-4700 or 1 (877) 357-9777 (toll-free).
Need more information?
¡At Triple-S we are here to serve you!
Call us at:
Triple-S Salud Provider Call Center
- 1-877-357-9777
- Monday through Friday from 7:30 a.m. to 8:00 p.m.
Saturdays from 8:00 a.m. to 12:00 p.m.
Plan Vital
Providers
- 1-844-263-6063
- Monday through Sunday from 7:00 a.m. to 7:00 p.m.
Triple-S Advantage Provider Call Center
- 1-855-886-7474
- Monday through Friday from 8:00 A.M to 5:00 p.m.
Saturdays from 8:00 a.m. to 2:00 p.m.
