Coverage profile
Work Medicare Puerto Rico Part B across every published route
Use the current payer record to choose the right claim-status, eligibility, portal, phone, or appeals workflow. Substrate only marks routes that are published for this payer.
Eligibility
EDI 270/271The Substrate Eligibility Agent can verify patient benefits, identify TPAs and carve-outs, and more with Medicare Puerto Rico Part B.
Portal claim status
Browser automationThe Substrate Claim Status Agent can check claim status via the payer portal for Medicare Puerto Rico Part B.
Other aliases
Also known as
- 09202
- SMPR0
- First Coast (FCSO) - Puerto Rico
- MEDICARE PART B PUERTO RICO (FIRST COAST)
- MEDICARE
2027 maternity billing research
When does Medicare Puerto Rico Part B change OB/GYN billing?
For CY 2027, CMS proposes maternity CPT valuations and seeks comment on an alternative of 15 HCPCS G-codes preserving the previous MMM global structure for Medicare PFS payment. Neither option is a finalized billing instruction in this source.
- Transition start
- CY 2027 proposal; operational transition date not established
- Billing start
- Not established by cited proposal
- Published
- 2026-07-16
- Current As Of
- August 2026
Scope: Federal Medicare PFS maternity-payment proposal for medical Part B services; not Puerto Rico-specific MAC instructions.
CY 2027 Physician Fee Schedule proposed rule. Verify the payer source before claim submission.
Frequently asked questions
Medicare Puerto Rico Part B payer FAQs
Can I automate Medicare Puerto Rico Part B portal follow-up?
Yes — portal retrieval is required when 276/277 is missing or stale. See payer portal automation and learn why 276/277 is not enough.
What is the payer ID for Medicare Puerto Rico Part B?
The primary payer ID for Medicare Puerto Rico Part B is SMPR0. The correct routing ID can differ by clearinghouse and transaction, so compare the 837P, 837I, 835, 270, and 276 entries before submitting.
What is the 837P payer ID for Medicare Puerto Rico Part B?
The 837P payer ID for Medicare Puerto Rico Part B is SMPR0 via Stedi.
What is the 835 payer ID for Medicare Puerto Rico Part B?
The 835 payer ID for Medicare Puerto Rico Part B is SMPR0 via Stedi.
What is the 270 payer ID for Medicare Puerto Rico Part B?
The 270 payer ID for Medicare Puerto Rico Part B is SMPR0 via Stedi.
What state does Medicare Puerto Rico Part B operate in?
Medicare Puerto Rico Part B operates in PR.
Routing reference
Medicare Puerto Rico Part B payer IDs and operating states
Use the payer ID listed for the transaction you are submitting. Verify current routing and enrollment requirements with your clearinghouse.
| Payer name | Medicare Puerto Rico Part BSource: Substrate payer directory · data last changed |
|---|---|
| Operating states | PRSource: Substrate payer directory · data last changed |
| 837P professional claims payer IDStedi | SMPR0Enrollment requiredSource: Stedi payer catalog · catalog dated · matched by payer ID |
| 835 ERA payer IDStedi | SMPR0Enrollment requiredSource: Stedi payer catalog · catalog dated · matched by payer ID |
| 270 eligibility payer IDStedi | SMPR0Enrollment requiredSource: Stedi payer catalog · catalog dated · matched by payer ID |
Routing sources and verification
- Substrate payer directoryPayer identity, aliases, operating states, and vendor IDs. Data last changed ; checked .Open payer website ↗
- Stedi payer catalogMatched by payer ID; matched record: Medicare Puerto Rico Part B. Source dated .PrimaryPayerId is used as the transaction payer ID when the corresponding Stedi support flag is true.Open current Stedi reference ↗
Clearinghouse payer IDs are transaction-specific and can change. Confirm the current payer list and the member’s ID card before submission.
Payer contact directory
Medicare Puerto Rico Part B phone and fax numbers
Use the number associated with your task. These contacts were stated in successful eligibility responses and may apply to specific benefits, products, or departments.
- Pharmacy phone
- (888) 888-9355WELLCARE PRESCRIPTION INSURANCE, INC.
| Channel and number | Payer Notes | Department | Specialties |
|---|---|---|---|
| phone(888) 888-9355 | PharmacyBenefit context: Other or Additional Payor |
| Pharmacy |
Phone and fax numbers sourced directly from the payer response