Frequently Asked Questions

1. Where are the FHC offices located?

 

The central office of FHC  is located at: Metro Office Park Valencia IBuilding 17 5th floor Guaynabo, Puerto Rico

The regional office is located at: Edificio Santander Ave. Hostos 209 Mayagüez, PR 00680 

Postal Address: 17 Calle 2 Suite 520 Guaynabo, PR 00968

 

2. What is the service hours and contact information of the Providers Department?

 

The service hour of the Provider Department is, Monday to Friday from 8:00 a.m. to 5:00 p.m. You may contact through the following means:

Phone: 1-877-684-4339

Fax: 1-866-912-2206

Email: [email protected]

3. Which are the medical plans/programs administered by FHC and for which I could request contracting? 

Commercial plans

     1. Triple SSS Municipios

     2. Triple SSS Federal

     3. MCS Solutions (PPO)

Medicare Advantage

     1. MCS Classicare

Employee Assitance Program (EAP)

4. What kind of professionals and facilities does FHC contract?

Professionals:

  • Psychologists
  • Psychiatrists
  • Geriatric psychiatrists
  • Psychiatrists of children and adolescents
  • Licensed Counselors
  • Clinical social workers

Facilities:

  • Psychiatric Hospitals
  • Psychiatric Units
  • Mental health partial treatment facilities
5. How can I request contract as a participating provider with FHC? Completing the referral form from the FHC website: www.fhcsaludmental.com
6. What are the contracting requirements?

Psychologists:

  •  Complete the credentialing application in its entirety and sign the contracts and rates that apply.
  •  Professional license as a psychologist to practice in Puerto Rico (current).
  • Master or Doctoral degree conferred by a university accredited by the state where the studies where completed:
    • Doctorate in Psychology  (PhD or PsyD)
    •  Master’s Degree in Psychological Counseling (MA)
  • Current Professional Liability Insurance endorsed to FHC with a minimum coverage of $100,000 to $300,000 (malpractice insurance).
  • Negative Certificate of Penal Record.
  • Have an office to receive patients. Obtain a result of 80% compliance or more in the evaluation of the facility.
  • Have an NPI number (National Provider Identifier)

Psychiatrists:

  • Complete the credentialing application in its entirety and sign the contracts and rates that apply.
  • Professional license as a psychiatrist to practice in Puerto Rico (current).
  • Have a current state and federal narcotics license (ASSMCA and DEA).
  • Current Professional Liability Insurance endorsed to FHC with a minimum coverage of $100,000 to $300,000 (malpractice insurance).
  • Copy of current membership of the Colegio de Médicos Cirujanos de Puerto Rico.·       Negative Certificate of Penal Record·
  • Have an office to receive patients. Obtain a result of 80% compliance or more in the evaluation of the facility.
  • Have an NPI number (National Provider Identifier). ​​

Social Worker:

  • Complete the credentialing application in its entirety and sign the contracts and rates that apply.
  • Permanent license as a Social Worker to practice in Puerto Rico issued by the Board of Examiners of Social Workers of Puerto Rico (valid).
  • Master or Doctorate degree conferred by a university accredited by the state where the studies were completed.
  • Current membership of the Colegio de Profesionales del Trabajo Social de Puerto Rico.
  • Current Professional Liability Insurance endorsed to FHC with a minimum coverage of $100,000 to $300,000 (malpractice insurance).
  • Negative Certificate of Penal Record.
  • Have an office to receive patients. Obtain an 80% compliance result or more in the evaluation of the facility.
  • Have an NPI number (National Provider Identifier).

Counselors:

  • Complete the credentialing application in its entirety and sign the contracts and rates that apply.
  • Professional license as a Counselor to practice in Puerto Rico issued by the PR Board of Directors Examiner.
  • Master or Doctorate degree conferred in a university accredited by the state where the studies were completed in some of the following clinical disciplines:
  • Psychological counseling Counseling of couples and family Mental health counseling Counselor in addiction
  • Current Professional Liability Insurance endorsed to FHC with a minimum coverage of $100,000 to $300,000 (malpractice insurance).
  • Negative Certificate of Penal Record
  • Have an office to receive patients. Obtain a result of 80% compliance or more in the evaluation of the facility.
  • Have an NPI number (National Provider Identifier).

Groups or Incorporated Practices:

  •  Complete the credentialing application in its entirety and sign the contracts and rates that apply.
  •  Have a Public Liability Insurance of the facility or facilities where the services will be provided.
  • Current Professional Liability Insurance endorsed to FHC with a minimum coverage of $100,000 to $300,000 (malpractice insurance).
  • The corporation must be registered in the Department of State of Puerto Rico.
  •  Have a social security number issued by the IRS.
  • Have an office to receive patients. Obtain a result of 80% compliance or more in the evaluation of the facility.
  • Have an NPI number (National Provider Identifier) ​​ on behalf of the corporation or localities.
  • All providers that apply must be credentialed by FHC before beginning to provide services.

7. How long does the credentialing process last?

 

FHC shall complete the credentialing process within sixty (60) calendar days from receipt the attestation and all applicable credentials and primary verifications.

8. When do I request the Good Standing of my license?

 

You can request the Good Standing as soon as you begin your credentialing or re-credentialing process. The Good Standing must be requested by the provider and must not have more than 180 days from the date of issue, until the date of presentation to the Credentialing Committee. The document must be endorsed to FHC and must be sent directly from the applicable Professional Board, to the postal address of FHC.
9. What are the evaluation requirements for an outpatient service office? The office must meet the following requirements, among others:

  1. Adequate physical access
  2. Appearance and adequacy of waiting and examining room space.
  3.  Comply with safety space and equipment requirements.
  4. Adequacy of medical record keeping.
  5. Confidentiality of records and any other medical information.
  6. Appointment and access standards.
  7. Inform members about the following:

          a. Rights and Responsibilities

          b. Written explanation of grievances procedures.

          c. Practitioner’s degree and license.

10. Where can I take or send the credentialing documents? 
  • By postal mail
  • In person to the offices of FHC
  • By Fax to 1-866-912-2206
  • By e-mail to [email protected]

 

11. What kind of services can I offer during a home visit?  Home visit are part of the MCS Classicare’s benefit only. Home visits include psychotherapy and medication management. Pre-authorization is required.
12. How often is the re-credentialing process performed once the provider is part of the FHC Network?  The re-credentialing occurs at least every three (3) years, from the most recent credentialing process.
13. If I want to know the status of my claims, what should I do?  You may contact the Providers Department at:

  • 1-877-684-4339 (Commercial plans)
  • 1.855.622.9804 (MCS Classicare)
14. What is the time limit to send a claim?  The provider has 90 days from the date of service to submit claims.
15. What is the time limit to submit a denied claim?  The provider has 20 days to submit a claim that has been denied.

16. What are the most frequent reasons for the denial of a claim?

 

The most frequent reasons are:

  1. Mental health diagnoses used in EAP services or vice versa.
  2. Services billed without authorization.
  3. Billing with unauthorized service codes.
17. Can I bill electronically? Providers in the FHC network are strongly recommended to submit all claims electronically.  To start the electronic claims submissions process you must contact a clearing house or by using a computer with software that meets electronic filing requirements.
18. What is a pre-authorization and what services require pre-authorization? 

Pre-authorization is an organization determination resulting from the case management process to determine whether requested treatment is medically necessary. Outpatient services that require preauthorization are:

  1. Partial hospitalization, including IOP
  2. Electroconvulsive Treatment (ECT)
  3. Home visits (MCS Classicare)
  4. Neuropsychological tests (MCS Classicare)
  5. Employee Assistance Program (EAP)
19. Does the provider need to be Medicare participant in order to be contracted for a Medicare Advantage plan administered by FHC? It is not necessary to be a Medicare participant to be a Medicare Advantage provider.

If your question has not been answered, please contact us here.