How can I become a provider for Medicaid and 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 and ask for Annabelle Estrada at Tel. 735-7472 Email: firstname.lastname@example.org
or Teresita Guamataotao at Tel. 735-7470 Email: email@example.com
What are the requirement to become a provider?
Get started by printing and filling out the Provider Application and Agreement Form
in legal form (8.5. x 14) and providing the following required documents and information:
Provider Application and Agreement (PAA) form in legal form (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 delivered to DPHSS Bureau of Health Care Financing Administration address below:
DPHSS Bureau of Health Care Financing Administration
123 Chalan Kareta
Mangilao, Guam 96913-6304
Telephone Number: (671) 735-7255/302/225/249/293
Fax Number: (671) 734-6860 / 735-7270
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