Starting with open enrollment, which began 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
Rich Pierznik, Vice President
Provider Contracting and Relations
UnitedHealthcare Community Plan of Delaware
Chief Operating Officer
***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 email@example.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.
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 and 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.
Diamond State Partners is a new managed care program, administered by the
Delaware Medical Assistance Program (DMAP) in partnership with participating
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.
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.