Puerto Rico

Claims & billing

Benefits Coordination & Recovery Center (BCRC)

Benefits Coordination & Recovery Center (BCRC)
Questions regarding — Claims & billing
Medicare Secondary Payer, and who pays first.
Toll free: (855) 798-2627

Carrier

First Coast Services Options, Inc.
Questions regarding — Claims & billing
Part B bills and services.
Toll free: (800) 633-4227

DME MAC -- Durable Medical Equipment Medicare Administrative Contractor

CGS Administrators, LLC
Questions regarding — Claims & billing
Bills for durable medical equipment and a list of approved suppliers of this equipment.
Toll free: (800) 633-4227

Fiscal Intermediary

Cooperativa De Seguros De Vida (COSVI)
Questions regarding — Claims & billing
Part A bills and services, hospital care, skilled nursing care, and fraud.
Toll free: (800) 633-4227

OIG (DHHS) -- Office of the Inspector General (Department of Health and Human Services)

Department of Health and Human Services - Office of Inspector General
Questions regarding — Claims & billing
Reporting fraud.
Toll free: (800) 447-8477
TDD: (800) 377-4950
Local Phone: (202) 619-1343

RHHI -- Regional Home Health Intermediary

Noridian
Questions regarding — Claims & billing
Home health, hospice care, and fraud.
Toll free: (800) 633-4227

RRB Carrier - Railroad Retirement Board Carrier

Noridian
Questions regarding — Claims & billing
(For Railroad Retirement beneficiaries only) - Part B bills and services.
Toll free: (888) 355-9165
Local Phone: (877) 288-7600

Complaints about my care or services

Accreditation Association for Ambulatory Health Care

Accreditation Association for Ambulatory Health Care
Questions regarding — Complaints about my care or services
Finding out if urgent care centers and ambulatory surgical centers are accredited or not.
Local Phone: (847) 853-6060

American Association for Accreditation of Ambulatory Surgical Facilities

American Association for Accreditation of Ambulatory Surgical Facilities
Questions regarding — Complaints about my care or services
Finding out if an ambulatory surgical center is accredited or not.
Toll free: (888) 545-5222
Local Phone: (847) 775-1970

American Board of Medical Specialties

American Board of Medical Specialties
Questions regarding — Complaints about my care or services
Finding out if a doctor is board certified.
Toll free: (866) 275-2267
Local Phone: (312) 436-2600

American Hospital Association

American Hospital Association
Questions regarding — Complaints about my care or services
Finding a voluntary list of patients' rights in a hospital.
Toll free: (800) 424-4301
Local Phone: (312) 422-3000

Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO)

Livanta, LLC
Questions regarding — Complaints about my care or services
Complaints about quality of care, and filing an appeal or complaint.
Toll free: (866) 815-5440
TDD: (866) 868-2289

Center for Health Dispute Resolution (CHDR)

MAXIMUS Center for Health Dispute Resolution (CHDR)
Questions regarding — Complaints about my care or services
Requesting external reviews of Medicare managed care denials.
Local Phone: (585) 425-5210

College of American Pathologists

College of American Pathologists
Questions regarding — Complaints about my care or services
Finding out if the lab where your blood tests are sent is accredited or not.
Toll free: (800) 323-4040
Local Phone: (847) 832-7000

ESRD -- End-Stage Renal Disease Networks

Quality Insights Renal Network 3 - formerly - Trans-Atlantic Renal Council - Network 3
Questions regarding — Complaints about my care or services
Where to submit a complaint about the quality of care I received from my kidney dialysis facility.
Toll free: (888) 877-8400
Local Phone: (609) 490-0310

ESRD State Survey Agency

Departamento de Salud
Questions regarding — Complaints about my care or services
Complaints about the quality of care in dialysis facilities.
Toll free: (800) 981-5721
Local Phone: (787) 765-2929

Joint Commission on Accreditation of Healthcare Organizations (JCAHO)

Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
Questions regarding — Complaints about my care or services
Finding out if your health care organization is accredited or not.
Local Phone: (630) 792-5800

Medicaid - Report Fraud

Puerto Rico Health Insurance Administration
Questions regarding — Complaints about my care or services
Report Medicaid fraud and abuse.
Toll free: (800) 981-2737
Local Phone: (787) 474-3300

Nursing Home State Survey Agency

Departamento de Salud (formerly - Department of Family Services and Children of Puerto Rico)
Questions regarding — Complaints about my care or services
Where to submit a complaint about the quality of life or quality of care inside a nursing home.
Local Phone: (787) 765-2929

Office for Civil Rights

Office for Civil Rights of New Jersey, New York, Puerto Rico, and Virgin Islands
Questions regarding — Complaints about my care or services
Submitting a complaint about discrimination.
Local Phone: (212) 264-3313

Ombudsman

Office of the Regional Administrator Region 2
Questions regarding — Complaints about my care or services
Obtaining information on nursing homes or resolving problems between nursing homes and residents or their families.
Local Phone: (787) 294-1681

Quality Innovation Network Quality Improvement Organization (QIN-QIO)

TMF
Questions regarding — Complaints about my care or services
Local and community level projects to improve patient safety, reduce harm, and improve clinical care.
Toll free: (800) 725-9216
TDD: (877) 486-2048
Local Phone: (512) 329-6610

Senior Medicare Patrol (SMP)

Office of the Ombudsman for Pensioners and the Elderly
Questions regarding — Complaints about my care or services
Complaints about quality of care, and filing an appeal or complaint.
Toll free: (800) 981-1202

General health & health conditions

Agency for Healthcare Research and Quality (AHRQ)

Agency for Healthcare Research and Quality (AHRQ)
Questions regarding — General health & health conditions
Ordering brochures on Choosing a Hospital. Choosing Treatments and Choosing a Hospital.
Toll free: (800) 358-9295
TDD: (888) 586-6340

American Association of Kidney Patients

American Association of Kidney Patients
Questions regarding — General health & health conditions
Educational materials for people with kidney disease.
Toll free: (800) 749-2257
Local Phone: (813) 636-8100

American Cancer Society

American Cancer Society
Questions regarding — General health & health conditions
Finding information on cancer.
Toll free: (800) 227-2345
TDD: (866) 228-4327

American Heart Association

American Heart Association
Questions regarding — General health & health conditions
Finding information on heart disease.
Toll free: (800) 242-8721
Local Phone: (214) 570-2000
Spanish Phone: (800) 242-8721

American Kidney Fund

American Kidney Fund
Questions regarding — General health & health conditions
Financial assistance and educational materials for people with kidney disease.
Toll free: (800) 638-8299
Local Phone: (301) 881-3052
Spanish Phone: (866) 300-2900

Internal Revenue Service

Internal Revenue Service
Questions regarding — General health & health conditions
Obtaining materials/forms for income tax filing and how Medicare Savings Accounts can affect my income taxes.
Toll free: (800) 829-1040

National Cancer Institute's Cancer Information Service

National Cancer Institute's Cancer Information Service
Questions regarding — General health & health conditions
Information on cancer treatments, clinical trails, alternative medicine, coping with side effects, and other cancer related information.
Toll free: (800) 422-6237

National Institute on Aging Information Center

National Institute on Aging Information Center
Questions regarding — General health & health conditions
Discussing health concerns, medicines, and other issues important to older people.
Toll free: (800) 222-2225
TDD: (800) 222-4225

National Kidney and Urologic Diseases Information

National Kidney and Urologic Diseases Information
Questions regarding — General health & health conditions
Educational materials for people with kidney disease.
Toll free: (800) 891-5390
Local Phone: (301) 654-4415

National Kidney Foundation, Inc.

National Kidney Foundation, Inc.
Questions regarding — General health & health conditions
Support groups and educational materials for people with kidney disease.
Toll free: (800) 622-9010
Local Phone: (212) 889-2210

Health care facilities & services in my area

American Self-Help Clearinghouse

American Self-Help Clearinghouse
Questions regarding — Health care facilities & services in my area
Finding specific health support groups in your area.
Toll free: (800) 367-6274
Local Phone: (973) 989-1122

Eldercare Location

DC longterm care Ombudsman program
Questions regarding — Health care facilities & services in my area
Finding necessary and convenient services that serve the elderly in their community.
Toll free: (800) 677-1116
Local Phone: (202) 434-2120

Primary Care Association

Associacion de Salud Primaria de Puerto Rico, Inc.
Questions regarding — Health care facilities & services in my area
Finding a Federally Qualified Health Center (FQHC) closest to me to help me lower my health care costs. FQHCs include community health centers, tribal health clinics, migrant health services, and health centers for the homeless.
Local Phone: (787) 758-3411

State Hospice Organization

Home Health and Hospice Association of Puerto Rico
Questions regarding — Health care facilities & services in my area
To find a hospice program in my area.
Toll free: (800) 981-2364
Local Phone: (787) 758-0168

Help with my Medicare options & issues

1-800-MEDICARE

1-800-MEDICARE
Questions regarding — Help with my Medicare options & issues
General Medicare information, ordering Medicare booklets, and information about health plans.
Toll free: (800) 633-4227

CMS RO - Centers for Medicare & Medicaid Services Regional Office

CMS, New York Regional Office
Questions regarding — Help with my Medicare options & issues
Information on local seminars and health fairs on Medicare health plan choices, or to report a complaint directly to CMS.
Toll free: (877) 449-5661
Local Phone: (212) 616-2222

RRB -- Railroad Retirement Board

Railroad Retirement Board
Questions regarding — Help with my Medicare options & issues
(For Railroad Retirement beneficiaries only) - RRB benefits, lost RRB Medicare card, address change, and enrolling in Medicare.
Toll free: (877) 772-5772

SHIP -- State Health Insurance Assistance Program

State Health Insurance Assistance Program (SHIP)
Questions regarding — Help with my Medicare options & issues
Personalized health insurance counseling
Toll free: (877) 725-4300
Local Phone: (787) 721-6121

SSA -- Social Security Administration

Social Security Administration
Questions regarding — Help with my Medicare options & issues
Changing my address, Medicare Part A or Part B, lost Medicare card, and Social Security benefits.
Toll free: (800) 772-1213

State Department of Insurance

Commissioner of Insurance of Puerto Rico
Questions regarding — Help with my Medicare options & issues
Medigap Policies
Toll free: (888) 722-8686
Local Phone: (787) 304-8686

Other insurance programs

CHIP -- Insure Kids Now

Children's Health Insurance Program
Questions regarding — Other insurance programs
Children's Health Insurance Program
Toll free: (877) 543-7669

Department of Defense

Department of Defense
Questions regarding — Other insurance programs
Whether I qualify for military retiree health care benefits.
Local Phone: (703) 571-3343

Department of Veterans Affairs

Department of Veterans Affairs
Questions regarding — Other insurance programs
VA medical benefits.
Toll free: (800) 827-1000

Federal Black Lung Program

Federal Black Lung Program
Questions regarding — Other insurance programs
Finding out where my doctor should send the bills for the diagnosis and treatment of my black lung disease.
Toll free: (800) 638-7072

HUD -- U.S. Department of Housing

U.S. Department of Housing and Urban Development (HUD)
Questions regarding — Other insurance programs
Information and services about homes and communities for citizens and for HUD's current and potential home buyers.
Toll free: (800) 569-4287
Local Phone: (202) 708-1112

Office of Personnel Management

Office of Personnel Management
Questions regarding — Other insurance programs
Claims and other issues for retired federal employees and their dependents/survivors.
Toll free: (888) 767-6738
TDD: (800) 878-5707
Local Phone: (202) 606-1800

State Medical Assistance Office

Medicaid Office of Puerto Rico and Virgin Islands
Questions regarding — Other insurance programs
Medicaid program
Local Phone: (787) 765-2929

About Puerto Rico

Puerto Rico[a] (Spanish for "Rich Port"; abbreviated PR), officially the Commonwealth of Puerto Rico (Spanish: Estado Libre Asociado de Puerto Rico, lit."Free Associated State of Puerto Rico")[b] and briefly called Porto Rico, is an unincorporated territory of the United States located in the northeast Caribbean Sea, approximately 1,000 miles (1,600 km) southeast of Miami, Florida.

An archipelago among the Greater Antilles, located between the Dominican Republic and the US Virgin Islands, Puerto Rico includes the eponymous main island and several smaller islands, such as Mona, Culebra, and Vieques. The capital and most populous city is San Juan. The territory's total population is approximately 3.4 million. Spanish and English are the official languages of the executive branch of government, though Spanish predominates.

Puerto Ricans have been citizens of the United States since 1917, and enjoy freedom of movement between the island and the mainland. As it is not a state, Puerto Rico does not have a vote in the United States Congress, which governs the territory with full jurisdiction under the Puerto Rico Federal Relations Act of 1950. However, Puerto Rico does have one non-voting member of the House called a Resident Commissioner. As residents of a U.S. territory, American citizens in Puerto Rico are disenfranchised at the national level and do not vote for the president or vice president of the United States, and only some residents pay federal income tax. Like other territories and the District of Columbia, Puerto Rico does not have U.S. senators. Congress approved a local constitution in 1952, allowing U.S. citizens of the territory to elect a governor. Puerto Rico's future political status has consistently been a matter of significant debate.

Source: Wikipedia