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By: Vilmar Trinta Negrón | Interview by: Lcdo. Tomás Hernández Del Toro
Federal Qualified Health Centers (FQHCs), commonly known as 330 Centers, will no longer be allowed to use multiple National Provider Identification (NPI) numbers to bill for services or submit reimbursement claims through the Provider Enrollment Portal (PEP) for the Medicaid Program in Puerto Rico.
As of September 1st, the new policy requiring consolidated NPIs for primary care providers enrolled in Puerto Rico’s Medicaid Program took effect. This regulation, defined in a publication from the Department of Health in May 2024, states that 330 Centers are not permitted to have more than one billing NPI at the same service location, regardless of the type of provider. The 330 Centers are non-profit organizations funded by the federal government, offering a wide range of medical services in one location, including primary care, mental health, pharmacy, laboratory, and radiology.
Regardless of the number of locations or provider numbers assigned to each location, the FQHC will be considered a single entity for reimbursement purposes, and all services provided by all entities under that FQHC will be reimbursed at the single rate applicable to that center.
Hernández emphasized that it is essential for all service providers to understand the consolidated number assigned by Medicaid, certify that it is properly contracted and configured by insurers, and ensure there are no denials.
The 330 Network in Puerto Rico operates nearly 115 clinics, including Mobile Units and School-Based Clinics, across 67 municipalities on the island, with more than two clinics in 12 of those municipalities.
Hernández Del Toro acknowledged that the consolidation process has faced challenges and hopes that in the next two months, discrepancies between the regulator and the centers will be resolved so that services continue and are adequately compensated.
He added that Provider Network Solutions, as the administrator of the Plan de Salud Menonita network, operates under the same conditions as any insurer. Therefore, they are obligated to act according to the regulatory files, and until these challenges are resolved, they will be unable to close any gaps with the regulator.
“Many of the services of the primary care groups that make up the Sistema de Salud Menonita and the insurer are made possible by these 330 Centers. There is a symbiotic relationship between the services they provide, the payment for those services, and access for the population to receive healthcare through them,” he stated.
The director recommended that insurer representatives engage in dialogue with the 330 Centers to gain better visibility of the agreements.
Finally, he reminded all components of the service chain involved in the claims process that they must be registered in the PEP to avoid claims being rejected by the insurer. This includes providers who order, prescribe, refer, provide, and bill for services to Medicaid beneficiaries (Vital and Platinum Plans).
If you have questions about provider registration in the Puerto Rico Medicaid Program, please contact the Medicaid Provider Enrollment Unit at (787) 641-4200 between 8:00 AM and 5:00 PM, Monday to Friday. You can also send your inquiry via email to: prmp-pep@salud.pr.gov.
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