PEP Validation Initiative Participating Plans
Every health provider that provides services to participants of the Government of Puerto Rico’s Vital Plan must be correctly registered in the Provider Enrollment Portal (PEP), according to the changes required by the PR Medicaid Program (PRMP).
It is important to note that, to avoid potential inconveniences, it is essential that all providers register with PEP and properly configure their billing system. Beginning May 15, 2024, any services provided without proper configuration could result in denials by participating Plan Vital health plans.
IMPORTANT LINKS
If you require assistance or validate your information in the Provider Enrollment Portal (PEP), you can contact:
Phone:
787-641-4200
Link:
Programa Medicaid – Departamento de Salud
Email:
prmp-pep@salud.pr.gov
- The Billing NPI must be registered in PEP prior to the date the service was provided. Otherwise you will be receiving a rejection with this note:
- N2088: PEP: Billing Provider NPI not registered or valid for DOS Medicaid Management Information System at Provider Enrollment Portal.
- The Zipcode +4 of the address where the service was offered (Service Facility Location Zipcode) must be registered in the PEP as a facility where the Billing NPI offers services. Otherwise you will be receiving a rejection with this note:
- N2070: PEP: Provider Address not registered or with discrepancies in Medicaid Management Information System at Provider Enrollment Portal.
- N2070: PEP: Provider Address not registered or with discrepancies in Medicaid Management Information System at Provider Enrollment Portal.
- The Rendering NPI reported in the claim must be associated with the corresponding Billing NPI in the PEP for the reported date of service. Otherwise you will be receiving a rejection with this note:
- N2071: PEP: Rendering provider not affiliated to billing in Medicaid Management Information System at Provider Enrollment Portal on date of service.
- N2071: PEP: Rendering provider not affiliated to billing in Medicaid Management Information System at Provider Enrollment Portal on date of service.
- **Not applicable to MMM** If the claim includes the referring or ordering physician information, the Referring or Ordering NPI must be recorded in the PEP for the reported date of service. Otherwise you will be receiving a rejection with this note:
- N2072: PEP: Referring Provider not active in Medicaid Management Information System at Provider Enrollment Portal on date of service.
PEP Guía de Inscripción Individual