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1. Print and complete the Medical Services Reimbursement Request
2. Send it together with the service receipt, to the address or fax number shown below
Triple-S Advantage, Inc.
Departamento de Reclamaciones
PO Box 11320
San Juan, Puerto Rico 00922
1. Request a coverage determination or appeal on behalf of a member
2. Both must submit this application by completing the following form
With limited exceptions, while you are a member of our plan you must use participating providers to get your medical services and care.
Necessary emergency care, urgency and dialysis services when network providers are temporarily unavailable or inaccessible, for example, if you are outside the service area in the United States and its territories.
In some of our plans you can get care from out-of-network providers when specialized service providers are not available in our network.
You or your doctor must request prior authorization.
Contact Member Services for more information on how to request prior authorization for out-of-network services.
For detailed information consult your Evidence of Coverage or contact the plan.
Triple-S Advantage, Inc.
Departamento de Farmacia
PO Box 11320
San Juan, PR 00922
Fax: (787) 620-0947
Triple-S Advantage, Inc. is an independent licensee of the BlueCross BlueShield Association. This allows us to interact with other BlueCross BlueShield (Host Blues) dealers through the Medicare Advantage Program.
If you get out-of-network services, claims will be processed through the Medicare Advantage Program and paid according to the current rules established in the Medicare Advantage Program policies that apply.
We have a network of pharmacies outside our service area where you can purchase your prescription as a member. Generally, we cover drugs filled at a non-participating network pharmacy only when you cannot use a participating pharmacy.
All organization determination or prior authorization requests are processed by TSA Clinical Operations according to CMS requirements.
TSA 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 after the date TSA receives the for a standard organization determination. TSA Clinical Operations is trained for processing and responding to organization determination requests.
Once the physician requests or determines medical necessity for a service, the medical order is sent with the proper/complete documentation by fax to (787) 620-0925 or 0926.
After this is received, dedicated teams of nurses will review the request and if there needs to be obtain more information, ordering physician is contacted to complete the request.
The member will received the approval by phone and mail and the provider will received by fax.
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.
Monday thru Sunday, from 8:00 am to 8:00 pm
Monday thru Friday, from 8:00 am to 5:00 pm
By clicking this link, you are leaving the website of Triple-S Advantage. If you need further assistance you may contact the Member Service Center of Triple-S Advantage at 1-888-620-1919. (TTY users should call 1-866-620-2520.) Hours are Monday through Sunday from 8:00 am to 8:00 pm.
Triple-S Advantage has a strong commitment to protecting the confidentiality of our members’ sensitive information. We take information privacy very seriously and it is important to us that our members are made fully aware of a potential privacy issue. We have learned that personal information of some of our members, including their name, health plan identification number, date of service in which treatment was provided, and treatment codes describing the service provided was mailed to the wrong address. The Social Security Numbers and date of birth of our members were NOT disclosed as a result of this incident.
On December 5, 2017, Triple-S Advantage discovered that notices sent in November 2017 to health care providers involved in the treatment of our members were mailed to the wrong address. However, we have not received any indication that the information has been accessed or used by an unauthorized individual.
Triple-S Advantage has performed an extensive investigation into why and how their personal information was disclosed. We have taken immediate steps to ensure additional notices to our members and your health care providers are sent to the correct address, such as: correction of the mailing process, completion of testings and sending the letters to the correct address of your provider. The members who may have been affected by this incident will receive first-class mail notices.
We have reported the incident to the required government agency, the Health Insurance administration of Puerto Rico (ASES) and will comply with the evaluation as required by the Office of Civil Rights within the time period established.
We are making an announcement about this incident so that affected Triple-S Advantage members can consider taking action to reduce the chances that their personal information will be misused:
If you or a family member belong to Triple-S Advantage and want additional information about the incident, you may contact our Customer Service Department from Monday through Sunday from 8:00 am to 8:00 pm at our toll-free number 1-888-620-1919, TTY users should call 1-866-620-2520 or by e-mail at: email@example.com.
You may also visit our Internet website advantage.grupotriples.com for further information.
If you are a Medicare Platino member, you can also contact the Health Insurance Administration of Puerto Rico (ASES) at or Customer and Providers Services Offices (PROBENE) at 1-800-981-2737/1-800-981-ASES from Monday through Friday 8:00 am to 4:30 pm, a Customer Services Representative will assist you. TTY users should call (787) 474- 3389. You can also contact us by email at firstname.lastname@example.org.
Triple-S Advantage sincerely apologize and regret this situation. The privacy and security of our member’s information is very important. We are working hard to strengthen our processes for the benefit and protection of our members.
Please Note: Triple-S Advantage will NOT call or email anyone requesting any personal information as a result of this incident. If you receive an unsolicited call or email that appears to be from Triple-S Advantage, your local hospital or physician office, please do not provide any personal information in response to these calls or emails.
Triple-S Advantage, Inc. complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Triple-S Advantage, Inc. cumple con las leyes federales aplicables de derechos civiles y no discrimina por razón de raza, color, origen de nacionalidad, edad, discapacidad, o sexo. Triple-S Advantage Inc. 遵守適用的聯邦民權法律規定，不因種族、膚色、民族血統、年 齡、殘障或性別而歧視任何人ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call: 1-888-620-1919 (TTY: 1-866-620- 2520). ATENCIÓN: Si usted habla español, servicios de asistencia lingüística están disponibles libre de cargo para usted. Llame al: 1-888-620-1919 (TTY: 1-866-620-2520). 注意:如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1-888-620-1919 (TTY: 1-866-620-2520)。
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Keep at hand the contact information of Triple-S Advantage providers. Fill out the form below to request a printed version of the document.