Forms
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
Facility
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
Materiales y Formularios
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.
Materials and Forms
Credential Requirements
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.
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
