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: firstname.lastname@example.org or Janet Cruz at Tel. 735-7471 Email: email@example.com.
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).
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.
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