Member Services

How to file a
complaint with Medicare?

Click on the link and submit your comments about your health plan or Medicare drug plan to help the Centers for Medicare and Madicaid Services continue to improve the quality of the program.

Submit a Complaint
with Medicare

How to request a reimbursement for medical services?

1. Print and complete the Medical Services Reimbursement Request

2. Send it together with the service receipt, to the address or fax number shown below

Triple-S Advantage, Inc.
Departamento de Reclamaciones
PO Box 11320
San Juan, Puerto Rico 00922-1320
Fax: 787-706-4015

REIMBURSEMENT
FORM

How do I appoint a representative?

1. Request a coverage determination or appeal on behalf of a member

2. Both must submit this application by completing the following form

Form to Appoint
a Representative

Rules for services outside the coverage area

Directorio
man

Apply now

your printed directory of suppliers

Request Directory

Organizational Determinations

All organization determination or prior authorization requests are processed by TSA Clinical Operations 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 Clinical Operations 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 (787) 620-0925 or 0926.

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.

Pre-authorization Referral Form

Medicare Advantage medical policies and internal coverage criteria

To access the Medicare Advantage medical policies and internal coverage criteria please access the following links:

I wish to receive information about the coverage products and services offered by Triple-S Advantage

You have:

By completing this form, you agree to a meeting with a sales agent to discuss the types of products you check above. Please note, the person who will discuss the products is either employed or contracted by a Medicare plan. They do not work directly for the Federal government. This individual may also be paid based on your enrollment in a plan.

This selection does NOT obligate you to enroll in a plan, it does not affect your current membership, and it will not enroll you in another Medicare plan.