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Last Modified: 11/23/2018 Location: PR Business: Part A, Part B

FAQs on provider enrollment revalidation cycle 2 for Puerto Rico providers

First Coast created frequently-asked questions (FAQs) to address common application issues that we experience for providers in Puerto Rico. Our goal is to assist you in updating information to prevent negative impacts once the revalidation application is submitted.
For revalidation applications, please remember providers/suppliers must submit a complete application by the Centers for Medicare & Medicaid Services’ (CMS’) established due date located at https://data.cms.gov/revalidation external link and respond to all requests for additional information issued by First Coast in a timely manner. No extensions for application submission will be granted. Failure to submit a revalidation application will result in a hold on Medicare payments and subsequent deactivation if the application is ultimately not submitted. If the revalidation application is received, but additional information is requested and not received within 30 days of the request, Medicare billing privileges will be deactivated.
1Q. Are providers in Puerto Rico required to submit their diploma with their applications?
1A. Yes, for initial, revalidation and reactivation applications, a Puerto Rico provider is required to submit their diploma with their application. The diploma is not required with a change of information application unless the change is directly related to the diploma.
The diploma, along with other documents, is required since there are not online websites and databases available for verification of Puerto Rico provider information.
2Q. Are providers in Puerto Rico required to submit a letter of good standing with their applications? How far in advance can the letter be dated prior to submission of the application?
2A. Yes, for initial, revalidation and reactivation applications, a Puerto Rico provider is required to submit a letter of good standing with their application. The letter of good standing is not required with a change of information application. The letter must be dated within 12 months prior to First Coast’s receipt of the application.
The letter of good standing, along with other documents, is required since there are not online websites and databases available for verification of Puerto Rico provider information.
3Q. I’m submitting my individual application for revalidation and I have been told that my supporting documentation must match my name as it appears on my social security card OR what is currently on file with the Social Security Administration (SSA), whichever is more current. What supporting documents should I check to ensure my name is listed correctly?
3A. Your name MUST be the same in the following documents and match the SSA file:
Appropriate sections within application [CMS-855 or internet-based Provider Enrollment, Chain and Ownership System (PECOS)]
Appropriate sections within electronic funds transfer (EFT) form (CMS-588) and any supporting documents (voided check, pre-printed deposit slip, or letter from the bank)
National provider identifier (NPI) information on the National Plan and Provider Enumeration System (NPPES) website
Documents that First Coast RECOMMENDS match:
Diplomas, degrees and certifications
Letter of good standing
Note: Name matching requirements are applicable for ALL applications, not just revalidations.
4Q. What if my supporting documents do not currently match the SSA file?
4A. First Coast STRONGLY recommends that providers take action now to update supporting documents, including banking information and NPPES website. Remember, you must still wait for your revalidation due date to be established prior to submitting your application.
5Q. I’m submitting an organization application for revalidation and I have been told that the supporting documentation must match the name as it appears with the Internal Revenue Service (IRS). What supporting documents should I check to ensure the organization’s name is listed correctly?
5A. The organization name MUST be the same in the following documents and match the IRS:
Appropriate sections within application [CMS-855 or internet-based Provider Enrollment, Chain and Ownership System (PECOS)]
Appropriate sections within electronic funds transfer (EFT) form (CMS-588) and any supporting documents (voided check, pre-printed deposit slip, or letter from the bank)
National provider identifier (NPI) information on the National Plan and Provider Enumeration System (NPPES) website
Documents that First Coast RECOMMENDS match (we will attempt to verify if they do not match exactly):
Licenses and certifications
Letter of good standing
For additional information on the revalidation process, please see the following resources:
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.