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***Get Health Reform Information 24/7***
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Attention: Medical Providers

ICD-10 Codes Used Effective October 1, 2015

All claims with a date of service on or after October 1, 2015 will be rejected if they do not contain valid ICD-10 codes.

Our system will not have the capability to accept ICD-9 codes for dates of service after September 30, 2015 or accept claims that contain both ICD-9 and ICD-10 codes.

***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 ***

The CMS 2014 Flexibility Rule has been implemented in the Delaware Medical Assistance Provider Incentive Repository (MAPIR). Please click here for information on the 2014 Electronic Health Record (EHR) Incentive Payment Program Year and Flexibility Rule. CMS has granted Delaware the following extensions for Program Year 2014:

  • Grace Period for EHs has been extended until 4/30/2015
  • Grace Period for EPs has been extended until 6/30/2015

Providers SHOULD NOT DELAY until the last day of the Grace Period to submit your attestations. 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.

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 Payment Error Rate Measurement (PERM)
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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Pharmacy Corner click here to go to the pharmacy section

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.

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.