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Be part of MSO or update your credentialing

Forms for New Providers, and Re-credentialing

We appreciate your interest to become a part of the MSO of Puerto Rico, LLC provider network. If you wish to join our Provider Network, please furnish the information required in our application form as it is applicable.

Provider

Request as provider
Instructions

Facility

Request as facility
Instructions

Questions on your application or re-credentialing process?

If you are in the process of credentialing or recredentialing, you must submit your credentials and the form found on this page electronically. If you need additional assistance, please contact us at the following e-mail address: credentialinghelpdesk@mso-pr.com.

If you need to update any credentials to keep your files current, please send the information to CredentialingUpdates@mso-pr.com.

You may contact us through the InnovaMD chat, by clicking the Credentials group

Learn credentialing requirements that may apply to you

requisites

Materiales y Formularios

Solicitud de Recredencialización para Proveedores
Solicitud para proveedores (médicos o profesionales de la salud) que estén en proceso de recredencialización.
Instrucciones para completar solicitud
Solicitud de Recredencialización para Facilidades
Solicitud para proveedores (hospitales, “Non Physician”, suplidores) que estén en proceso de recredencialización.
Instrucciones para completar solicitud
Solicitud de Cambios para Proveedores
Para prooveedores  (médicos y profesionales de la salud) que deseen solicitar hacer un cambio en la contratación.
Solicitud de Cambios para Facilidades
Para proveedores (hospitales, “Non Physician”, suplidores) que deseen solicitar un cambio en la contratación.

Medical Policies

Our medical policies define the way in which MMM Holdings LLC, and its subsidiaries identify and evaluate specific services’ requisitions through the application of clinical guidelines. The guidelines refer to the National and Local Coverage Determinations (NCD and or LCD) and/or Articles defined by the Centers for Medicare and Medicaid (CMS) and/or any other clinical criteria. The policies reflect current scientific research and evidence-based clinical guidelines standards.

View all Policies

Materials and Forms

Provider Request Form - Initial Application
Application for providers (doctors or health professionals) who are in the process of re-credentialing.
Instructions to complete the application
Facility Request Form - Initial application
Application for providers (hospitals, “Non Physician”, suppliers) that are in the process of re-credentialing.
Instructions to complete the application
Provider Request Form - Recredentialing Application
For providers (doctors and health professionals) who want to request a change in hiring.
Facility Request Form - Recredentialing Application
For providers (hospitals, “Non Physician”, suppliers) who want to request a change in the hiring.

Contracted Provider

If you are an MSO contracted provider (facilities or individual), you may use any of the following processes, with the forms below:

  • For changes in your demographic record, send the information to: FrontLoading@mso-pr.com. Upon receipt, and after approval, your information will be updated in our systems within 20 days.
  • If you wish to request a modification on your contract, you must complete the form and email it to: providerrequest@mso-pr.com. Upon receipt, your request will be evaluated and a determination will be issued within 10 days. Please select the applicable form.
Change request

Should you need further information,
please call Provider Services at:

787-993-2317 (Metro Area)
1-866-676-6060 (toll free)

Monday through Friday from 7:00 AM to 7:00 PM