Providers Service Center

Thank you for your interest in registering and using the Provider Portal of the Puerto Rico Health Insurance Administration (“ASES,” for its Spanish acronym). This service is offered exclusively for Providers of the ASES Vital Program and their Authorized Representatives. Please review and agree to the following terms and conditions before proceeding.

ASES is committed to the protection of the privacy of Vital Providers when accessing and using our website. Reasonable best efforts are made to ensure that the information you submit is used only for purposes intended for the use of this Portal, and otherwise remains private to the extent feasible. During the registration process, specific information may be requested from you. ASES does not disclose any information provided in connection with those requests to any outside parties, except to manage the Vital Program or as required by law.

Providers should designate on the Portal a Primary Representative from their office. This Primary Representative will have the ability to add Authorized Representatives within their office to the Portal.

Registration Instructions: Both the information below and acceptance of the attached Agreement is required in order to complete registration.If you have any questions, please contact Customer Service at 787-474-3300 or 1-800-981-2737.

Definitions

The terms below as used in this Agreement shall be defined as follows:

• “Administrator” means the Puerto Rico Health Insurance Administration (“ASES,” by its Spanish acronym).
• “Authorized Representative" means an individual that a Provider has authorized to use the Portal on Provider’s behalf.
• “Member” means the person who is receiving health care items or services under the Vital program.
• “MCO(s)” means the managed care organizations contracted with the Administrator under the Vital program.
• “Vital” means the government managed care program operated by ASES by a Memorandum of Understanding with the Puerto Rico Medicaid Program, under the Puerto Rico Department of Health, for the provision of health care items and services to Members.
• “Primary Representative” means the Authorized Representative in the Provider’s office who has responsibility for adding, deleting and maintaining the names of the Provider’s Authorized Representatives.
• “Provider” means the signatory to this Agreement, contracted to provide health care items or services to Vital Members.
• “Service” means the authorized access and use of the Secure Web Portal and supporting website under this Agreement.
• “Treatment” means, in accordance with 45 CFR 164.501, the provision, coordination, or management of health care and related services by one or more health care providers, including the coordination or management of healthcare by a health care provider with a third party; consultation between health care providers relating to a patient; or the referral of a patient for health care from one health care provider to another.

Introduction

This Provider Secure Web Portal Agreement (“Agreement”) contains the terms and conditions that govern the use of this Secure Web Portal Service between the Administrator and an authorized user(s) for access to information on eligibility, claims payments, prior authorization, and other authorized functions. ASES maintains this site in connection with its administration of the Vital program in Puerto Rico.

Use of the Secure Web Portal Service

The Secure Web Portal Service provides access to eligibility and health information of Members of the Vital Program for authorized users. The Provider shall use this Service solely in connection with its provision of health care items or services to Members of the Vital program. All users, including Providers, Primary Representative(s), and Authorized Representative(s), shall use the portal solely within the appropriate scope and conduct of his or her employment or agency with Provider. Users shall access and use the portal subject to the following:

1. The terms and conditions of this Agreement; and
2. The applicable provisions of Provider’s contract with MCOs contracted by ASES to provide health care items and services to Vital Members (the “Provider Contract”). The applicable provisions of the Provider Contract include, but are not limited to, the use and disclosure of protected health information under the HIPAA privacy standards, member eligibility verification, utilization management standards as set forth within MCO policies and the Provider Handbook, and timelines for submission and resubmission of claims.

In the event of a conflict between this Agreement and the Provider Contract, this Agreement shall govern.

Provider shall require the Primary Representative and Authorized Representative(s) to (1) keep confidential and not disclose the Provider’s password to any person except Provider or the Primary or Authorized Representative; (2) use the Service solely in connection with Provider’s provision of health care items and services to Members of the Vital program, and solely within the appropriate scope and conduct of his or her employment or agency with Provider; and (3) use the Service pursuant to the terms and conditions of this Agreement and the Provider Contract. Provider shall be deemed ultimately responsible for the Primary Representative and Authorized Representative(s) of the Service.

Upon discovery that the Primary or Authorized Representative(s) (1) has violated any of the conditions set forth above, or (2) no longer works for or represents Provider, Provider shall immediately revoke such Representative’s authority to use the Service on behalf of the Provider. Provider shall also notify the Administrator when it has revoked a Primary Representative’s or Authorized Representative’s authority to use the Service for any other reason. The Provider shall revoke the Primary Representative’s or Authorized Representative’s authority to use the Service if directed to do so by Administrator.

If a Primary or Authorized Representative(s)’ authority is revoked, the Provider shall immediately delete such person’s access to the Service and designate a new Primary Representative or Authorized Representative, as required, in accordance with the terms and conditions of this Agreement.

Use of Member Health Information

The Provider shall treat all Member health information displayed on the Member Care Information Portal or otherwise made available through the Service in accordance with the applicable provisions of the HIPAA Privacy Standards, 42 CFR Part 2, and any other applicable federal or Puerto Rico laws, regulations or guidance governing the privacy and security of health information.

With respect to Member health information relating to the treatment of drug or alcohol abuse or addiction, this information has been disclosed to you from records protected from certain disclosures by applicable federal laws, regulations and guidance on patient confidentiality, including but not limited to 42 CFR Part 2. These federal rules prohibit you from making any further disclosure of this information unless further disclosure is expressly permitted by the written consent of the person to whom it pertains or as otherwise permitted by 42 CFR Part 2. A general authorization for the release of medical or other information is NOT sufficient for this purpose. The federal rules also restrict any use of this information to criminally investigate or prosecute a patient.

Changes to the Portal Service or this Agreement

The Administrator may, at any time, make changes to the Service, the terms and conditions under this Agreement, or any other applicable requirements that govern the use of the Service at any time. The Provider should review the Secure Web Portal and this Agreement periodically for any updates or changes. The Provider’s continued access or use of the Service shall be deemed as the Provider’s acknowledgement, notification and acceptance of these changes.

Warranties

The Administrator uses reasonable methods to provide accurate and current information on member eligibility, health information, claims submissions, and prior authorization(s) available through the Service. However, because of the possibility of technical and human error, as well as other factors, there is no implied warranty of any kind, including of representation about the accuracy, completeness, or appropriateness or fitness for a particular purpose of this Service. While the Administrator uses reasonable methods to secure the Secure Web Portal, there is no warranty that the Service will be free from corrupted data, computer viruses or similar destructive or contaminating code.

IN PARTICULAR, THE MEMBER HEALTH INFORMATION APPEARING ON THE PORTAL MAY NOT REPRESENT A FULL OR ACCURATE PICTURE OF A MEMBER’S HEALTH HISTORY. PROVIDERS SHOULD RELY UPON ALL AVAILABLE SOURCES OF INFORMATION BEFORE RECOMMENDING, IN THEIR OWN PROFESSIONAL JUDGMENT, ANY COURSE OF TREATMENT FOR A MEMBER.

Liabilities

The Administrator shall not be held liable for any known or unknown delay, difficulty in use, inaccuracy or incompleteness of information, computer viruses, malicious code, loss of data, compatibility issues, or otherwise. Providers are to use this Service at its own risk. The Administrator will not be liable for any direct, indirect, incidental, consequential, or punitive damages arising out of Provider’s use of or access to the Service or any other linked or accompanying websites or functions. By its use of the Service, the Provider accepts that the Service may not perform as intended despite the best efforts of the Administrator, the Provider, or any internet service providers.

Ownership, License and Restrictions on Use of Materials

As between the Administrator and the Provider, all rights, titles and interests (including all copyrights, trademarks and other intellectual property rights) to and in the Service belong to the Puerto Rico Health Insurance Administration.

The Provider is hereby granted a nonexclusive, nontransferable, limited license to view and use information retrieved through the Service solely in connection with its provision of health care items or services to the Members of Vital. Except as expressly stated above, no part of the information made available through the Service, including but not limited to materials retrieved from it and the underlying code, may be reproduced, republished, copied, transmitted, sold or distributed in any form or by any means unless as expressly permitted by law. In no event shall materials from this Portal be stored in any information storage and retrieval system of the Provider or any other entity without prior written permission from the Administrator.

The Provider’s use of this Service allows the Administrator to gather certain limited information about the Provider and its use of the Service. The Provider agrees and consents to the Administrator’s use of such information in aggregated form.

Site System Integrity

The Provider may use the Portal for normal use in connection with its provision of health care items or services to Members of Vital. The Provider may not use any device, software, routine, or agent to interfere or attempt to interfere with the proper function and use of the Service. The Provider may not take any action that imposes an unreasonable or disproportionately large load on the underlying technical or operational infrastructure of the Service. The Provider may not disclose or share passwords to or with third parties, except with an Authorized Representative, or use or allow the use of passwords for any unauthorized purpose. The Provider shall take reasonable precautions to secure passwords from any unauthorized use. The Provider may not attempt to log-in to use the Service with a user name or password other than its own.

Continuous, uninterrupted access to the Service is not guaranteed. Numerous actions beyond the Administrator’s control may interfere with the use of the Service.

Service Restriction

Subject to all applicable laws and regulations, the Administrator reserves the right to suspend or deny Provider’s access to all or any portion of the Service for cause in its sole discretion with or without notice. The Provider agrees that suspension or termination of the Provider’s access to the Service may be effected immediately and without prior notice. Further, the Provider agrees that the Administrator shall not be liable to the Provider or any third party for any suspension or termination of the Provider’s access to the Service.

Agreement Termination

Either party may terminate this Agreement at any time. The Administrator may also immediately suspend or terminate this Agreement with the Provider and Provider’s access to the Service if, in the sole discretion of the Administrator, the Provider breaches this Agreement.

Upon termination of this Agreement, the Provider agrees to destroy all materials obtained from use of the Portal site, as well as all related documentation, copies, and installations, whether or not made in accordance with the terms and conditions set forth under this Agreement.

The person(s) signing this Agreement warrants that he or she has full authority to do so and that the signature below binds the Provider, including the Provider’s owners, employees, agents and representatives, on whose behalf the person below signs.