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ACA Provider Screen ing and Enrollment
ACA Eligibility
ACA Health Exchange
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ACA Provider Screening and Enrollment Frequently Asked Questions

  1. What is the purpose of the Rule?
  2. Should I expect changes to the enrollment process?
  3. What is the new screening process?
  4. What can I expect from DMAP?
  5. Who is considered an Ordering/Referring/Prescribing provider?
  6. How are Ordering/Referring/Prescribing providers affected?
  7. Did you know?
  1. What is the purpose of the Rule?

    To prevent or combat fraud, waste, and abuse under the Medicare and Medicaid programs and CHIP.

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  2. Should I expect changes to the enrollment process?

    Yes, DMAP is updating enrollment applications to incorporate the ACA requirements and guidelines. DMAP will also enhance provider and supplier screening techniques, manage institutional provider application fees, and increase disclosure information requirements.

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  3. What is the new screening process?

    DMAP already screens all potential applications for the enrollment process. However, the new ACA requirements necessitate additional database screening for providers, managing staff and those with five percent ownership. Some providers will also have unannounced pre- and post- enrollment site visits.

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  4. What can I expect from DMAP?

    • Service - we are dedicated to providing the Healthcare Community with the most up-to-date information.
    • Support - our knowledgeable staff is here to assist providers through this transition.


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  5. Who is considered an Ordering/Referring/Prescribing provider?

    • A provider that is not fully enrolled with DMAP and will never be paid by DMAP: but places orders, refers to another provider, or prescribes for a DMAP recipient is considered to be an Ordering/Referring/Prescribing provider. For example,
      • Doctors of Medicine, Osteopathy, Dental Surgery, Dental Medicine, Podiatric Medicine, Optometry, or Chiropractic Medicine
      • Physician Assistants
      • Certified Clinical Nurse Specialists, Nurse Practitioners, Certified Nurse Midwives
      • Clinical Psychologist
      • Clinical Social Workers
      • Audiologists and Hearing Aid Dispensers


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  6. How are Ordering/Referring/Prescribing providers affected?

    • In the future, these providers will be required to complete a streamlined application via the DMAP website.


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  7. Did you know?

    • The Centers for Medicare and Medicaid Services (CMS) re quires States to deny claims from providers who are not enrolled in the State's Medicaid or CHIP programs. These claims include reimbursement for services rend ered, prescriptions, referrals, and orders for lab work and tests. Enroll in the Delaware Medical Assistance Program (DMAP) today!


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