What is a payment determination or reimbursement?
A determination of payment is any determination made by MCS, whether an approval or denial. A reimbursement is the request to receive all or part of the money that was disbursed by the member for a medical or dental service.
How can you request a Reimbursement?
Receipts for reimbursement must be legible and must include the following information:
Note: Individual cash receipts, canceled checks, receipts for money orders, personal breakdowns and invoices indicating only “Balance Due” are not acceptable. Forms that do not contain the requested information may delay the processing of your refund or be returned to you.
You or an authorized representative must send your written request by mail to the following address:
MCS Advantage, Inc.Attention: Claims DepartmentP O Box 191720San Juan, PR 00919-1720
If you need information or assistance, you can call us at:Toll free: 1-866-627-8183TTY/TDD only: 1-866-627-8182
Reimbursement Request (for medical or dental services) 2025
WRITEMCS Advantage, Inc.Attention: Claims DepartmentP O Box 191720San Juan, PR 00919-1720
CALL Toll Free: 1-866-627-8183 TTY 1-866-627-8182