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?
The form, credentials, and documents required must be sent to: providerrequest@mso-pr.com.
If you are in a re-credentialing process, please send credentials and form to: 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
Materials and Forms
Application for providers (doctors or health professionals) who are in the process of re-credentialing.
Application for providers (hospitals, “Non Physician”, suppliers) that are in the process of re-credentialing.
For providers (doctors and health professionals) who want to request a change in hiring.
For providers (hospitals, “Non Physician”, suppliers) who want to request a change in the hiring.
Credential Requirements
Check the credential requirements for Primary Physicians, Specialists, Facilities, Pharmacies and DME.
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