PROVIDERS FREQUENTLY ASKED QUESTIONS
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. (671) 735-7472 Email: annabelle.estrada@dphss.guam.gov or Janet Cruz at Tel. (671) 735-7341 Email: janet.cruz@dphss.guam.gov.
What are the requirement to become a provider?
Get started by printing and filling out the Guam Medicaid and MIP Provider Application and Agreement form and providing the following required documents and information:
- Guam Medicaid and MIP Provider Enrollment Application and Checklist_June 2023
- Guam Medicaid and MIP Provider Enrollment Disclosure of Ownership and Control Interest Statement_June 2023
- PPA must include the start date for each provider name listed on the agreement form.
- Vendor Record / Electronic Funds Transfer (EFT) Authorization Form
- W9 Form
- 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 Identifier (NPI), Drug Enforcement Administration (DEA), Control Substances Registration (CSR), Business Associate Agreement (BAA)).
- Medicare Approval/Certificate (if applicable)
- Provide three (3) authorized full names for the release of an Explanation of Benefits (EOB).
The original Provider Application and Agreement along with the above-required documents and information must be mailed or delivered to the Bureau of Health Care Financing Administration address below:
Bureau of Health Care Financing Administration
Castle Mall
#130 University Drive, Unit 7
Mangialo, Guam 96931
Telephone Number: (671) 735-7472 / 735-7471
Fax Number: (671) 735-7476
How do I submit my claims?
There are several ways to submit your claims for payment.
- Electronic submission via clearinghouse – System Interface
- Online submission via U-Log – Claims Self Data Entry
- Paper submission to DPHSS via hand-delivery