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***Get Health Reform Information 24/7***
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Open Enrollment begins November 1, 2014. Program Changes in January 2015

Several changes will take place in the Medicaid program on January 1, 2015.
  1. The Division of Medicaid and Medical Assistance will discontinue the Diamond State Partners (DSP) Program.
  2. Delaware Physician's Care, Inc. (Aetna) will no longer be a managed care option in the Delaware Medicaid Program.
Two managed care plans will be offered to Medicaid and CHIP members. They are UnitedHealthcare and Highmark. Starting with open enrollment, which begins November 1, all Medicaid members will have the opportunity to select the MCO of their choice. All Medicaid-covered services will continue to be available regardless of the MCO chosen. MCOs will work collaboratively to ensure continuity of care, especially for those members with existing care plans.

Consumer questions should be directed to the Health Benefits Manager at 1-800-996-9969.

Provider questions can be directed to the health plans at:

     Highmark Health Options
     Gary E. Krichhof Director
     Provider Contracting and Network Development
     Phone: 302.421.8850


     UnitedHealthcare Community Plan of Delaware
     Denaire Johnson
     Chief Operating Officer
     Phone: 302.781.6734


***Attention Institutional Providers***

CMS defines an institutional provider as any provider that submits the following forms for enrollment: CMS-855A, CMS 855B, CMS 855S and associated PECOS enrollment applications. Individual Physicians and non-physician practitioners are not subject to the application fee. Providers who are enrolled in or have paid the application fee to Medicare or another State’s Medicaid or CHIP Program are exempt from paying the fee to DMAP. For providers who do not meet any of the exception criteria, Medicaid application fees are due at enrollment and re-enrollment. CMS requires States to impose an application fee on institutional providers for program integrity purposes. The enrollment fee is established by CMS and is updated annually. Providers may request a hardship exception from CMS as needed.

*** EHR Updates ***

Program Year 2013 of the EHR Provider Incentive Payment Program has closed. MAPIR (Medical Assistance Provider Incentive Repository) must be updated to reflect Program Year 2014 CMS regulations. Program Year 2014 applications may not be submitted or completed until April 2014. Any submitted applications will be aborted and will need to be resubmitted in April 2014 after MAPIR is updated. The April 2014 start date will be announced through a future DMAP update. For questions, contact the Provider Incentive Payment team at 1-800-999-3371, option 0, option 3 or via e mail at delawarepipteam@hp.com

**** June 2013 ACA Section 1202 Web Attestation Form ****

Web Attestation Form should now be submitted electronically. Please see the attached alert for more details.

PCP Attestation Alert

To submit an attestation form, please sign into the interactive services tab.

**** Pharmacy Tip of the Day ****

Click here to learn how to submit pharmacy prior authorizations online to expedite the process:
How to submit online prior authorizations
How to check the status of an online prior authorization
The Medicare Prescription Drug Coverage information can now be found on the Downloads tab under the Forms link.

State of Delaware Announcement for Medicaid Services

Effective April 1, 2012, providers are to start billing the MCOs for covered services for clients enrolled in Diamond State Health Plan Plus.

Managed Care Organization Contact information as of April 2012 for DSHP Plus:

UnitedHealthcare
LTC Provider Services 800-600-9007
LTC Member Services 877-542-9248

www.uhccommunityplan.com

Delaware Physicians Care
Provider Relations 800-287-9860
Member Services 888-437-6875
www.delawarephysicianscare.com

Other Contact numbers:
HP Enterprise Services Provider Relations Department Call Center (1-800-999-3371)
Medicaid Fraud, Waste and Abuse reporting (1-800-372-2022)


Select this link for  Pharmacy Corner

Select this link for ICD-10
Select this link for Provider Incentive Program for Electronic Health Records (EHR)
Select this link for On-Line Provider Disclosure
Select this link for DMAP E-mail Registration.
Select this link for Dental Prior Authorization Forms.
Select this link for Delaware Cancer Treatment Program Forms.
Select this link for ePrescribing Information.
Select this link for Affordable Care Act (ACA) Information
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Welcome to the DHSS Provider Community!


Delaware Health and Social Services (DHSS) is the agency that is responsible for the overall administration of the Medicaid Program (Title XIX) and various other medical assistance programs for the State. The administration process is handled at the operational level through the Delaware Medical Assistance Program (DMAP) as part of the Division of Medicaid and Medical Assistance (DMMA). The purpose of the DMAP is to furnish medical assistance to eligible families of low-income doctor with xray imageand to eligible people who are aged, blind and/or disabled whose income and resources are insufficient to meet the cost of necessary medical services. Medical coverage provided under Medicaid includes hospital, outpatient clinic, lab and physician services, prescriptions, nursing home care and many other medical services. Services are available through providers statewide who contract with DSS.

DSP logo

Welcome to Diamond State Partners

Diamond State Partners is a new managed care program, administered by the Delaware Medical Assistance Program (DMAP) in partnership with participating providers.
Any active DMAP Provider who currently bills EDS for Medicaid clients can also bill EDS for services to a client enrolled in Diamond State Partners. The same 10-digit DMAP Provider Number issued to a Medicaid provider can be used for Diamond State Partners. If you are a Medicaid provider then you are a Diamond State Partners provider. If you would like more information about enrolling as a Diamond State Partners provider, call DSP Member Services at 800-390-6093 or
For forms and more policy information regarding DSP, click here DSP information.

Welcome to the Pharmacy Corner mortar icon

The pharmacy program in Delaware is operationally administered through the Delaware Medical Assistance Program (DMAP) in concert with EDS staff that includes a Pharmacy Consultant and Pharmacy Team. The objective of the pharmacy program is to ensure that Medicaid clients have access to appropriate medications while monitoring utilization and cost-effectiveness. The rapid changes in the pharmacy industry and the importance of communicating new information to the pharmacy community are critical to the quality and continuity of care for Delaware citizens. The Pharmacy Corner can be accessed through this link for pharmacy-related issues and data.

This site was designed for use by the medical provider community. If you are looking for personal state health programs please refer to the Delaware State Web Page .


Electronic verification systems are available 24 hours a day, 7 days a week except during routine maintenance outages that will be periodically scheduled on Sundays between 7PM and 12AM Eastern Time.


This site follows the same Privacy Policy and Disclaimer as the DHSS web site.