Providers


Certification for Motorized Scooter and Wheelchair

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Certification for Bath/Shower Chair

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Certification for Blood Pressure Monitor

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Certification for Non-Emergency Ambulance Transportation

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Request for Special Coverage Registry

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Certification for Therapeutic Shoes

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Request for Pre Authorization

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Request for Durable Medical Equipment

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Notice of Medicare Non-Coverage (FastTrack-Livanta)

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Organizational Determinations

All organizational determinations (pre authorizations) are processed by the Medical Management staff at Triple-S Advantage, according to Medicare requirements. Triple-S Advantage will notify the member of its determination as expeditiously as the member’s health condition requires, but no later than 72 hours (for expedited determinations) or 14 calendar days (for standard cases). The Medical Management staff is trained to process and respond to organizational determination requests.

Once the physician determines medical necessity for an assessment or procedure:

  • The physician should send the medical order by fax to Triple-S Advantage at 787-620-0925 or 0926
  • The order is processed and reviewed by the Medical Management staff
    • If additional information is required, our personnel will contact the physician or the member to obtain it
  • Once the order is approved, we will contact the member by phone and send the authorization letter by mail
  • The provider will also receive the authorization letter by fax

Payment dispute for non-contracted providers

A payment dispute is a disagreement between a non-contracted provider and the Medicare Advantage Organization (MAO) regarding the amount or level paid for a Medicare-covered service. The non-contracted provider will have 120 days from the initial determination to file the dispute.

What do you need to do to file a non-contracted payment dispute?

The non-contracted provider can file a dispute by sending the following forms with the necessary supporting documentation to the address listed below:

Non-Contracted Provider Payment Dispute Form
Waiver of Liability Spa 

Triple-S Advantage, Inc.
Claims Department
Re: Provider Payment Dispute
PO Box 11320
San Juan, Puerto Rico 00922

Get in touch with our experts:

Sales Representative

1-877-207-8777

TTY/TDD Users

Monday through Friday
from 8:00 a.m. to 8:00 p.m.

I am undecided. Please call me to provide some guidance.

By completing this form, you as a beneficiary or authorized representative agree to have one of our sales representatives contact you to discuss the products Triple-S Advantage offers under Part C. Please be aware that the person calling you is a Medicare employee or subcontractor. They do not work directly with the federal government. This person could receive compensation based on your plan enrollment.

This selection does NOT obligate you to enroll in a plan, it does not affect your current membership, and it will not enroll you in another Medicare plan.

Get to Know Medicare

Member Service

1-888-620-1919

TTY/TDD users

1-866-620-2520

Monday thru Sunday, from 8:00 am to 8:00 pm

Service for Providers

1-855-886-7474

Monday thru Friday, from 8:00 am to 5:00 pm

Teleconsulta

1-800-255-4375

Teleconsejo

1-877-879-5964

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