For Providers

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Certification for Motorized Scooter and Wheelchair


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Certification for Bath Chairs


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Certification for Blood Pressure Monitor


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Certification for Non Emergency Transportation


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Request for Special Coverage Registry


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Certification for Utilization of Therapeutic Shoes


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Request for Pre Authorization


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Request for Durable Medical Equipment


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Notice of Medicare Non-Coverage (FastTrack-Livanta)


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Organization determinations

All organization determination or prior authorization requests are processed by TSA Medical Management staff 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 staff 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 TSA MM department. 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.

Payment dispute for non-contracted providers

A payment dispute is a disagreement between a non-contracted provider and the Medicare Advantage Organization (MAO) about the amount or level paid for a Medicare covered service. The non-contracted provider will have 120 days from the initial determination to file the dispute.

What do you need to do to file a non-contracted payment dispute?

Non-contracted provider can file a dispute sending the Non-Contracted Provider Payment Dispute Form and Waiver of Liability with the supporting documentation (see Instructions) to:

Triple-S Advantage, Inc.
Claims Department
Re: Provider Payment Dispute
PO Box 11320
San Juan, Puerto Rico 00922

Last update: 10/01/2016

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