Provider Information

How to become a Provider for Medicaid / MIP

Please contact the Bureau of Health Care and Financing Administration office located at the Castle Mall in Mangilao, Monday to Friday, 8:00am to 5:00pm. Closed on the weekends and GovGuam Holidays. Ask for Anhabelle Estrada at Tel. 735-7472 Email: annabelle.estrada@dphss.guam.gov or Janet Cruz at Tel. 735-7471 Email: janet.cruz@dphss.guam.gov.

What documents are needed to become a Provider?

Get started by printing and filling out the Provider Application and Agreement in legal paper size (8.5. x 14) and include the following required documents and information:
  • Provider Application and Agreement (PAA) form in legal paper size (8.5.x14). Download here.
  • PPA must include start date for each provider name listed on the agreement form.
  • Vendor Electronic Funds Transfer (EFT) Authorization form. Download here.
  • Vendor Record form. Download here.
  • Copy of Guam Business License/Certificate of Exemption
  • Employer Identification Number (EIN)
  • Tax Identification Number (TIN)
  • Copy of current Professional License/Certificates indicated on PAA.
  • Certification Information (Curriculum Vitae, Diploma, National Provider information (NPI), Drug Enforcement Administration (DEA), Control Substances Registration (CSR), Business Associate Agreement (BAA)).
  • Medicare Approval/Certificate (if applicable)
  • Provide three (3) authorized full name for the release of Explanation of Benefits (EOB).
  • The original Provider Application and Agreement (PPA) along with the above required documents and information must be mailed or hand-delivered to DPHSS Bureau of Health Care Financing Administration address below:

    Department of Public Health & Social Service
    Bureau of Health Care Financing Administration
    ITC Building Ste 219
    590 S Marine Corps Dr
    Tamuning, Guam 96913-3532

    How long will it take to review my Provider Application and Agreement?

    It may take up to 2 to 3 working days to review and process your application.  Once approved a notice will be sent you via email.

    How to Change/Update Your Information

    Please contact immediately the Bureau of Health Care and Financing Administration to report any changes/updates to your information.   To include providing all necessary documents.

    How do I submit my claims?

    There are several way to submit your claims for payment.
  • Electronic submission via clearing house – System Interface
  • Online submission via U-Log – Claims Self Data Entry
  • Paper submission to DPHSS via hand delivery.
  • Forms

  • Provider Application and Agreement Form
  • Vendor Electronic Funds Transfer (EFT) Authorization Form
  • Vendor Records Update Form
  • Providers Frequently Asked Questions (FAQs)

    Click HERE for Provider FAQs
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