dhss logo

dmap title

skip the navigation menu and view the content of this page or select ALT-C to access
home buttoninformation buttondownload buttonlink buttoninteractive services button


What's New
Contacts
 
 
 
NPI Archives
 
 
 
What's New Archives
 
 
 
 

What's New

All notices prior to April 2008 have been moved to an archive page.
To view these notices please select the "What's New Archives" link at the left of this page.
Date Link
(2/6/12) General Policy Manual General Policy Manual
Revision Date: 2/6/12
Sections Revised: 12.1 and 12.2
Update to procedure codes 11975 and 11977, they have been discontinued effective 1/1/2012 as part of the recent HCPCS update.
(1/20/12) Pharmacy Billing Manual Pharmacy Billing Manual
Revision Date: 1/20/12
Section Revised: 2.3.2
The D.Ø payer sheet has been updated.
(1/11/12) Dental Provider Specific Manual Dental Provider Specific Manual
Revision Date: 1/11/12
Sections Revised: 3.2
Clarification for interceptive orthodontics.
(1/9/12) Outpatient Hospital Provider Manual Outpatient Hospital Provider Manual
Revision Date: 1/9/12
Sections Revised: 3.2
Guidance regarding dental services provided in an outpatient setting.
(1/3/12) DME Policy Provider Specific Manual DME Policy Provider Specific Manual
Revision Date: 1/3/12
Section Revised: 1.2 and 7.1.3
Defined home and removed the website address for Region A Durable Medical Equipment Regional Center.
(1/3/12) General Policy Manual General Policy Manual
Revision Date: 1/3/12
Sections Revised: 1.21, 8.1, and 18.2
Guidance on Prior Authorization processes added.
(12/13/11) Dental Provider Specific Manual Dental Provider Specific Manual
Revision Date: 12/13/11
Sections Revised: 3.0, 4.2
Added root canal therapy guidance. Updating anesthesia guidelines.
(12/9/11) Dental Provider Specific Manual Dental Provider Specific Manual
Revision Date: 12/9/11
Sections Revised: 10.0
Updated the Dental Prior Authorization Forms to reflect that DMMA is no longer receiving them via fax but rather via email.
(12/6/11) Pharmacy Billing Manual Pharmacy Billing Manual
Revision Date: 12/6/11
Section Revised: 2.2, 2.3.2
Guidance regarding National Council for Prescription Drug Programs (NCPDP) claims. The payer sheet has been updated.
(12/2/11) General Policy Manual General Policy Manual
Revision Date: 12/2/11
Sections Revised: 1.22
Added tobacco cessation guidance.
(11/17/11) DME Policy Provider Specific Manual DME Policy Provider Specific Manual
Revision Date: 11/17/11
Section Revised: 3.7
Added DMAP reimbursement current practices.
(11/1/11) General Policy Manual General Policy Manual
Revision Date: 11/1/11
Sections Revised: 3.1.2
Guidance regarding National Council for Prescription Drug Programs (NCPDP) claims.
(11/1/11) EVS Manual EVS Manual
Revision Date: 11/1/11
Section Revised: Section 1.4
Guidance regarding National Council for Prescription Drug Programs (NCPDP) claims.
(11/1/11) Pharmacy Billing Manual Pharmacy Billing Manual
Revision Date: 11/1/11
Section Revised: 2.2.1
Removed obsolete wording.
(10/3/11) General Policy Manual General Policy Manual
Revision Date: 10/3/11
Sections Revised: 1.24
Effective November 1, 2011, the DMAP will allow for Labor/Delivery Services Only to be provided in a birthing center.
(10/4/11) DME Policy Provider Specific Manual DME Policy Provider Specific Manual
Revision Date: 10/4/11
Sections Revised: 7.1
Based on the removal of the Prior Authorization requirement for commodes, nebulizers, and walkers DMAP policy updated.
(10/4/11) Pharmacy Provider Specific Manual Pharmacy Provider Specific Manual
Revision Date: 10/4/11
Sections Revised: 4.1.9
Guidance added to direct pharmacy providers to use diagnosis codes when billing, if on the prescription.
(9/21/11) Dental Provider Specific Manual Dental Provider Specific Manual
Revision Date: 9/21/11
Sections Revised: 8.0
Adjustments completed for accuracy based on the changes dated 09/09/2011.
(9/9/11) Dental Provider Specific Manual Dental Provider Specific Manual
Revision Date: 9/9/11
Sections Revised: 5.0, 8.0, 3.2 and 10.0
Removed the prior authorization requirement for the following codes: D2951, D2952, and D2954. D8210 and D8220 are no longer covered dental services. Updated guidance for the following codes, D7140, D7210, D7220, D7230, D7240, and D7241. Reduced age limit to 5 years old for D0330. Added billing guidance for orthodontists when client(s) lose eligibility. Updated the Interceptive Orthodontic Prior Authorization Request form to include the following requirement, a panorex and photograph.
(9/9/11) Outpatient Hospital Provider Manual Outpatient Hospital Provider Manual
Revision Date: 9/9/11
Sections Revised: 3.2
Effective May 6, 2011, it is no longer necessary to submit prior notification to DMMA regarding outpatient facility and anesthesia charges for dental procedures under age 21 for codes 41899 and 00170.
(8/29/11) Home Health Provider Manual Home Health Provider Manual
Revision Date 8/29/11
Sections Revised: 5.2
Updated the face-to-face policy. The policy changes in 5.2 override the policy updates published on 04/20/2011.
(8/18/11) Clinic Provider Policy Specific Clinic Provider Policy Specific
Revision Date: 8/18/11
Section Revised: 10.17
Added proper billing code effective 10/01/2010.
(8/5/11) Pharmacy Billing Manual Pharmacy Billing Manual
Revision Date: 8/5/11
Section Revised: 2.7.1
Updated the DMAC Pricing Inquiry Worksheet for Generic Drug.
(7/14/11) DME Policy Provider Specific Manual DME Policy Provider Specific Manual
Revision Date: 7/14/11
Sections Revised: 8.6
Added row to Additional Miscellaneous Supplies section.
(6/24/11) DME Policy Provider Specific Manual DME Policy Provider Specific Manual
Revision Date: 6/24/11
Sections Revised: 12.0
Removed obsolete Certificate of Medical Necessity (CMN) forms no longer used by Medicare.
(6/24/11) General Policy Manual General Policy Manual
Revision Date: 6/24/11
Sections Revised: 1.6
Added guidance on how DMAP will handle FDA issued consent decree(s) for drug or device manufacturers.
(5/3/11) General Policy Manual General Policy Manual
Revision Date: 5/3/11
Sections Revised: 1.10
Updated the section on Fraud or Abuse Reporting.
(4/20/11) General Policy Manual General Policy Manual
Revision Date: 4/20/11
Sections Revised: 6.0
Updated provider appeals procedures.
(4/20/11) Home Health Provider Manual Home Health Provider Manual
Revision Date 4/20/11
Sections Revised: 3.4, 5.2.2, 5.2.3, 5.2.4
Updated requirements for face to face encounters
(3/16/11) DME Policy Provider Specific Manual DME Policy Provider Specific Manual
Revision Date: 3/16/11
Sections Revised: 3.1.1, 4.1.2
Updated wording, added sections 4.1.2.1, 4.1.2.1.1, 4.1.2.1.2
(3/14/11) Pharmacy Provider Specific Manual Pharmacy Provider Specific Manual
Revision Date: 3/14/11
Sections Revised: 2.1.7
Primary insurer clarification.
(3/16/11) General Policy Manual General Policy Manual
Revision Date: 3/16/11
Sections Revised: 2.3.6, 2.3.7, 8.2
Deleted Payment Authorization reference.
(3/8/11) Practitioner Provider Specific Manual Practitioner Provider Specific Manual
Revision Date: 3/8/11
Sections Revised: 12.1
Removal of obsolete language regarding the reimbursement of hospital based emergency room physicians who are independent of the hospital.
(3/4/11) DME Policy Provider Specific Manual DME Policy Provider Specific Manual
Revision Date: 3/4/11
Sections Revised: 8.0
Updates to codes:A4565,A4566,A4399,A5112,A6261,A6262,A7013,A7020
(2/11/11) Pharmacy Provider Specific Manual Pharmacy Provider Specific Manual
Revision Date: 2/11/11
Sections Revised: 2.1.4
Clarification to the record retention policy.
(2/11/11) General Policy Manual General Policy Manual
Revision Date: 2/11/11
Sections Revised: 1.39
Added a new section for Program Integrity.
(2/4/11) Dental Provider Specific Manual Dental Provider Specific Manual
Revision Date: 2/4/11
Sections Revised: 3.2.3.1, 3.2.4 and 8.0
Update to prior authorization documentation requirements for D8060 and update to the comprehensive orthodontic definition.
(1/12/11) Outpatient Hospital Provider Manual Outpatient Hospital Provider Manual
Revision Date: 1/12/11
Sections Revised: Appendix K
Updated the Medicaid Top 20 Physician-Administered Multiple Source Drugs.
(1/14/11) General Policy Manual General Policy Manual
Revision Date: 1/14/11
Sections Revised: 12.1
Added missing family planning procedure code, 00851.
(1/3/11) Dental Provider Specific Manual Dental Provider Specific Manual
Revision Date: 1/3/11
Sections Revised: 4.1 and 4.8
Update to reflect current dental code clarification and addition of 2011 dental codes.
(12/20/10) Home Health Provider Manual Home Health Provider Manual
Revision Date 12/20/10 Sections Revised: 3.0 and 5.0
Effective 01/01/2011 the Affordable Care Act mandates the face-to-face encounter requirement.
(12/13/10) General Policy Manual General Policy Manual
Revision Date: 12/13/10
Sections Revised: 6.0
Updated provider appeals policy to include state-contracted entities.
(12/8/10) DME Policy Provider Specific Manual DME Policy Provider Specific Manual
Revision Date: 12/8/10
Sections Revised: 3.5.4
Updated the Purchase Versus Rental information.
(12/8/10) Elderly and Disabled Waiver Provider Policy Manual Elderly and Disabled Waiver Provider Policy Manual
Revision Date: 12/8/10
Sections Revised: All
Consolidated E and D Waiver effective 12/01/2010 and removed the ABI and Assisted Living Waiver policy.
(11/9/10) Inpatient Policy Provider Specific Manual Inpatient Policy Provider Specific Manual
Revision Date: 11/9/10
Sections Revised: 2.8.1.3
Update to reflect change in outlier reimbursement.
(11/4/10) General Policy Manual Revision Date: 11/4/10
Sections Revised: 1.21.6.16.1 and 12.2
1.21.6.16.1 - Added Federally Qualified Health Center to the list of providers that do not require prior authorization for services in region.
12.2 - 2011 diagnosis code changes for contraceptive management.
(10/27/10) Dental Provider Specific Manual Dental Provider Specific Manual
Revision Date: 10/27/10
Sections Revised: All
Effective November 1, 2010 - Revised and updated the entire Dental Provider Policy.
(9/28/10) General Policy Manual Revision Date: 9/21/10
Sections Revised: 1.20.2.5 and 1.20.3.5
Added procedure code documentation requirements.
(9/20/10) Pharmacy Provider Specific Manual Pharmacy Provider Specific Manual
Revision Date: 9/10/10
Sections Revised: 1.1.2.6 and 1.1.2.7
Added language to address pharmacy retro enrollment.
(9/20/10) Inpatient Policy Provider Specific Manual Inpatient Policy Provider Specific Manual
Revision Date: 9/13/10
Sections Revised: 2.8.1.3
Clarification regarding payment of outpatient services for inpatient recipients.
(9/15/10) Dental Provider Policy Update Dental Provider Policy Update
Revision Date: 9/15/10
Please download and review prior to 11/1/10 effective date
(9/01/10) AIDS Waiver Provider Specific Manual Attention Taxonomy: 103TH0100X
AIDS Waiver Provider Specific Manual
Revision Date: 9/01/10
Sections Revised: 2.1
Added wording to HCBS Provider Responsibilities.
(8/10/10) DME Provider Manual DME Provider Specific Manual
Revision Date: 8/10/10
Sections Revised: 8.0
The requirement for prior authorization for some procedure codes has been updated.
(7/12/10) Private Duty Nursing Provider Specific Manual Private Duty Nursing Provider Specific Manual
Revision Date: 7/12/10
Section Revised: 5.1.2
Added the Acquired Brain Injury Medicaid Waiver to the subsection
(7/12/10) General Policy Manual General Policy Manual
Revision Date: 7/12/10
Sections Revised: 17.1, 17.2, 17.3, 17.4, 17.5, 17.6, 17.7, 17.8
Update of childhood and adolescent vaccination and catch-up immunization schedule for 2010
Sections Revised: 1.21 through 1.21.6.16.3
Updated and clarified Prior Authorization policy and the final order for this regulation appeared in the June 1, 2010 issue of the Delaware Register.
(7/12/10) DME Provider Manual DME Provider Specific Manual
Revision Date: 7/12/10
Sections Revised: 3.1.12
Addition of subsection regarding items not primarily medical in nature
Sections Revised: 1.2.4
Addition of bullet point regarding diapers routinely used for children under four years of age
Sections Revised: 3.1.4, 3.7.2.1 through 3.7.6
Added cost/price sheets as a requirement when submitting a Medicare or Medicaid Certificate of Medical Necessity (CMN), and EPIC Plus clarification
Sections Revised: 8.17
Code limit changes to reflect updated Prior Authorization policy
(7/12/10) Inpatient Hospital Provider Policy Manual Inpatient Manual
Revision Date 7/12/10
Sections Revised: 2.5 through 2.5.9.9
Added section on transplants
Sections Revised: 2.9 through 2.9.3
Added section on bariatric surgery
(7/12/10) Outpatient Hospital Provider Manual Outpatient Hospital Provider Manual
Revision Date: 7/12/10
Sections Revised: 3.11.5 through 3.11.5.2.4
Addition of section regarding prior authorization for PET scans and computed tomograhpic colonography
Sections Revised: 3.12 through 3.12.2.2
Addition of section regarding Sleep Testing
Sections Revised: Appendix E
Addition of form 50-36 Positron Emission Tomography (PET) Scans
(7/12/10) Dental Provider Policy Specific Manual Dental Provider Policy Specific Manual
Revision Date: 7/12/10
Sections Revised: 5.0, 5.1
Added Prior Authorization section
(7/12/10) Practitioner Provider Specific Manual Practitioner Provider Specific Manual
Revision Date: 7/12/10
Sections Revised: 1.14.8 through 1.14.8.9.9
Addition of transplants subsection
Sections Revised: 1.14.9 through 1.14.9.3
Addition of bariatric surgery subsection
Sections Revised: 1.15 through 1.15.1.2
Removed the subsection titled Non-Invasive Therapy
Sections Revised: 7.3 through 7.3.2.4
Addition of section regarding prior authorization for PET scans and computed tomographic colonography
Sections Revised: 1.15 through 1.15.2.2
Addition of section regarding Sleep Testing
(6/03/10) Hospice Provider Specific Manual Hospice Provider Specific Manual
Revision Date: 6/03/10
Section Revised: 8.3
Update of hospice provider policy to meet Section 2302 of the Affordable Care Act.
(5/25/10) General Policy Manual General Policy Manual
Revision Date: 5/25/10
Section Revised: 6.0
Updated provider appeals procedures.
(3/26/10) General Billing Information General Billing Information
Revision Date: 3/26/10
Section Revised: 2.7
Made Adjustment Request Form a fillable form.
(4/19/10) HCBS/DD Waiver Manual HCBS/DD Waiver Manual
Revision Date 4/19/10 Sections Revised: All
Replaced references to Mentally Retarded with Developmentally Disabled.
(4/19/10) Home Health Provider Manual Home Health Provider Manual
Revision Date 4/19/10 Sections Revised: 6.1.6, 6.2.7.1 and 6.3.11.1
Replaced references to Mentally Retarded with Developmentally Disabled.
(4/19/10) Hospice Provider Specific Manual Hospice Provider Specific Manual
Revision Date: 4/19/10
Section Revised: 1.1.7
Removed obsolete wording.
(4/21/10) General Policy Manual General Policy Manual
Revision Date: 4/21/10
Section Revised: 1.22.1.1.2
Updated Medicaid Eligibility Groups and Covered Services subsection.
(4/29/10) E-mail Notification Registration Please download and review the instructions for registering to receive DMAP e-mail notifications.
(4/29/10) Interactive Services Registration Please download and review the instructions for registering for Interactive Services
(3/31/10) General Policy Manual General Policy Manual
Revision Date: 3/31/10
Section Revised: 6.0
Updated provider appeals procedures.
(3/26/10) CMS-1500 Billing Manual CMS-1500 Billing Manual
Revision Date: 3/26/10
Sections Revised: 2.5
Removed obsolete wording
(3/25/10) Outpatient Hospital Provider Manual Outpatient Hospital Provider Manual
Revision Date: 3/26/10
Sections Revised: Appendix K
Updated the Medicaid Top 20 Physician-Administered Multiple Source Drugs.
(3/12/10) General Policy Manual General Policy Manual
Revision Date: 3/12/10
Section Revised: 7.0
Made the Referral for Fraud and Abuse form a fill-able form.
(2/8/10) General Policy Manual General Policy Manual
Revision Date: 2/8/10
Section Revised: 7.0
Updated the Referral for Fraud and Abuse form.
(1/19/10) Practitioner Provider Specific Manual Practitioner Provider Specific Manual
Revision Date: 1/19/10
Sections Revised: 1.4.1
Update to reflect that for dates of service January 1, 2010 and after, the Delaware Medical Assistance Program (DMAP) will no longer cover inpatient and outpatient/office consultation codes.
(1/19/10) DME Provider Manual DME Provider Specific Manual
Revision Date: 1/19/10
Section Revised: 8.4, 8.6, and 8.14
Updates made to various procedure codes to reflect the 2010 HCPC updates.
(1/19/10) General Policy Manual General Policy Manual
Revision Date: 1/19/10
Section Revised: 1.21.12
New procedure codes have been added for Computed Tomographic Colonography which requires Prior Authorization.
(12/30/09) ABI Provider Policy Manual ABI Provider Policy Manual
Revision Date: 12/30/09
Section Revised: 4.1
ABI Requirements update.
(12/21/09) General Policy Manual General Policy Manual
Revision Date: 12/21/09
Section Revised: 1.11.6
Added CMS mandate that Medicaid is able to facilitate the recovery of Medicare overpayments.
(12/21/09) Assisted Living Manual Assisted Living Manual
Revision Date: 12/21/09
Section Revised: 2.1.7
Clarification of the services included in the hospice per diem.
(12/15/09) General Policy Manual General Policy Manual
Revision Date: 12/15/09
Section Revised: 1.12
Updates made to the General Documentation Requirements section.
(11/11/09) Pharmacy Provider Specific Manual Pharmacy Provider Specific Manual
Revision Date: 11/11/09
Sections Revised: 4.1.4.2
Effective 10/14/2009 updated the Estimated Acquisition Cost (EAC) for traditional and independent pharmacies.
(11/11/09) Ambulatory Surgical Center Provider Specific Manual Ambulatory Surgical Center Provider Policy Specific Manual
Revision Date: 11/11/09
Sections Revised: 3.0
Updated the Non-ASC/FSSC Facility Services example to include dental services.
(11/11/09) School-Based Services Provider Specific Manual School-Based Services Provider Policy Specific Manual
Revision Date: 11/11/09
Sections Revised: 9.0-Appendix B
Added Code G9008 to Appendix B - Codes and Descriptions of School Based Health Services.
(10/30/09) Practitioner Provider Specific Manual Practitioner Provider Specific Manual
Revision Date: 10/30/09
Sections Revised: 1.14 and 29.0 - Appendix N
Bariatric surgery was added to the list of exclusions in Section 1.14. Appendix N was updated to "Reserved for Future Use".
(10/30/09) Pharmacy Provider Specific Manual Pharmacy Provider Specific Manual
Revision Date: 10/30/09
Sections Revised: 3.3
Removed the reference to Appendix F.
(09/21/09) Outpatient Hospital Provider Manual Outpatient Hospital Provider Manual
Revision Date: 09/21/09
Sections Revised: 5.4 and Appendix K
Effective 10/1/2009 (regardless of date of service) Outpatient hospitals are required to submit claims for drugs that are listed in Appendix K - Medicaid Top 20 Physician-Administered Multiple Source Drugs.
(9/21/09) Practitioner Provider Manual Practitioner Provider Manual
Revision Date 9/21/09
Section Revised: 1.11.3
Updated to replace the requirement for a DEA number with the NPI.
(10/1/09) Proposed Dental Provider Policy Specific Manual Proposed Dental Provider Policy Specific Manual
Revision Date: 10/1/09
(9/01/09) Inpatient Hospital Provider Policy Manual Inpatient Manual
Revision Date 9/01/09
Sections Revised 1.8.1
Clarification of dental services.
(8/24/09) General Policy Manual General Policy Manual
Revision Date: 8/24/09
Section Revised: 17.1
Updated to reflect the CDC updated recommendations for the poliovirus vaccination.
(8/5/09) DME Provider Manual DME Provider Specific Manual
Revision Date: 8/5/09
Section Revised: 3.7.2.2
Clarification made regarding EPIC Plus (pricing software) timeframes for their automated updates., A4235 and A4236.
Section Revised: 3.7.3.3
Clarified and defined list price
(7/14/09) General Policy Manual General Policy Manual
Revision Date: 7/14/09
Section Revised: 17.1, 17.2, 17.3, 17.4, 17.5, 17.6, 17.7 and 17.8
Update of the childhood and adolescent vaccination and catch-up immunization schedule for 2009.
(7/13/09) Practitioner Provider Manual Practitioner Provider Manual
Revision Date 7/13/09
Sections Revised: 30.0 Appendex O
Corrected the wording to the Periodicity schedule regarding the number of visits for early childhood years, between the ages of 2 and 3.
(6/30/09) General Policy Manual General Policy Manual
Revision Date: 6/30/09
Section Revised: Section 14, Appendix I
Changes and clarification made to the various MCBR forms and instructions.
Revision Date: 7/6/09
Section Revised: 1.21.5.1.7
Added intestinal transplants as a covered service.
(5/27/09) EVS Manual EVS Manual
Revision Date: 5/27/09
Section Revised: Section 1.4
Defines e-prescribing providers ability to access patient eligibility information.
(6/26/09) General Policy Manual General Policy Manual
Revision Date: 6/26/09
Added Provider Taxonomy to Appendices
(6/26/09) Pharmacy Provider Specific Manual Pharmacy Provider Specific Manual
Revision Date: 6/26/09
Effective 07/01/2009 updated the Estimated Acquisition Cost (EAC) for traditional and independent pharmacies.
(6/5/09) Pharmacy Billing Manual Pharmacy Billing Manual
Revision Date: 6/5/09
Section Revised: 2.2.1
Clarification and instruction provided to verify eligibility in emergency situations.
(6/5/09) Pharmacy Provider Specific Manual Pharmacy Provider Specific Manual
Revision Date: 6/5/09
Section Revised: 3.3.2
Clarification and instruction provided to verify eligibility in emergency situations.
(6/4/09) Renal Dialysis Facility Provider Specific Manual Renal Dialysis Facility Provider Specific Manual
Revision Date: 6/4/09
Sections Revised: 5.2.1
Effective July 1, 2009, providers who bill using a Renal Dialysis taxonomy must bill their charges using the lesser of the facility's usual and customary (U & C) charges or 100% of the Medicare reimbursement rate.
(6/4/09) Rehabilitation Agency Provider Specific Manual Rehabilitation Agency Provider Specific Manual
Revision Date: 6/4/09
Sections Revised: 4.2.1
Updated the incorrect UB92 wording to the correct wording, UB04.
(5/27/09) General Policy Manual General Policy Manual
Revision Date: 5/27/09
Sections Revised: 3.4
Defines e-prescribing providers ability to access patient eligibility information.
(5/26/09) Ambulatory Surgical Center Provider Specific Manual Ambulatory Surgical Center Provider Specific Manual
Revision Date: 5/26/09
Sections Revised: 5.1
Update to reflect the change in how rates are paid.
(4/30/09) General Policy Manual General Policy Manual
Revision Date: 4/30/09
Sections Revised: 1.23
Clarification of income limits for SLIMBs and QI1s.
Revision Date: 5/21/09
Sections Revised: 1.21.1
Added minimum documentation requirement specifics.
Sections Revised: 1.13.2
Reimbursement clarification .
(05/20/09) Hospital Outpatient & Outpatient Crossover Claims Guidelines for including NDC information List of guidelines for including NDC information on hospital outpatient and outpatient crossover claims
(04/8/09) Dental Provider Policy Specific Manual Dental Provider Policy Specific Manual
Revision Date: 04/08/09
Sections Revised: Revision Table
Added the required CDT end user licensing agreement as a pop-up dialogue box.
(4/30/09) Hospice Provider Specific Manual Hospice Provider Specific Manual
Revision Date: 4/30/09
Section Revised: 1.1.4 - Clarified the wording which addresses how providers are paid for servicing institutionalized individuals.
(4/22/09) Practitioner Provider Manual Practitioner Provider Manual
Revision Date 4/22/09
Sections Revised: 1.2
Update to define our requirements that the practitioner(s) signature is on all medical records.
(4/16/09) School-Based Services Provider Specific Manual School-Based Services Provider Specific Manual Revision Date: 4/16/09
Section Revised: 7.0 - Clarified the description which introduces the newly added billing example chart.
(4/8/09) School-Based Services Provider Specific Manual School-Based Services Provider Specific Manual Revision Date: 4/8/09
Section Revised: 7.0 - Clarified billing with example chart.
(4/8/09) Hospice Provider Specific Manual Hospice Provider Specific Manual
Revision Date: 4/8/09
Section Revised: 10.0 - Replaced current Patient.s Hospice Activity Dates form with updated form
Section Revised: 7.1 - Clarified Hospice Notification Requirements
Section Revised: 5.0 - Added new section titled General Inpatient Care
Section Revised: 9.0 - Added revenue code 0657 Section Revised: 4.1 - Clarified billing instructions for Physicians Services
(4/15/09) Pharmacy Provider Specific Manual Pharmacy Provider Specific Manual
Revision Date: 4/15/09
Section Revised: 5.3.2.4
Change in overutilization rate from 75% to 83%.
(4/1/09) DME Provider Manual DME Provider Specific Manual
Revision Date: 4/1/09
Section Revised: 8.0
Added the asterisk indicator notifying providers that no prior authorization is required for the following codes: A4218, A4233, A4234, A4235 and A4236.
(4/1/09) Pharmacy Provider Specific Manual Pharmacy Provider Specific Manual
Revision Date: 4/1/09
Section Revised: 3.4.2.12, 2.1.6, 4.1.4.2 and 5.3.2.4
Added the Drug Utilization Review (DUR) Board's titration suggestion for reduction of the number of unique medications use per 30 days. Added the policy changes that reflect reduced agency spending.
(03/11/09) Outpatient Hospital Provider Manual Outpatient Hospital Provider Manual
Revision Date: 03/11/09
Sections Revised: 5.3.2
Update to the policy which reflects the change in form numbers from UB92 (old form number) to UB04 (new form number).
(02/12/09) Dental Billing Manual Dental Billing Manual
Revision Date: 02/12/09
Sections Revised: 2.3
Added required legal wording for use of ADA coding.
(02/12/09) General Policy Manual General Policy Manual
Revision Date: 02/12/09
Sections Revised: 1.20.3.4
Added new procedure code wording which references the legal ADA criteria for dental coding.
(02/12/09) Dental Provider Policy Specific Manual Dental Provider Policy Specific Manual
Revision Date: 02/12/09
Sections Revised: 11.0 and 12.0
Added required legal wording for use of ADA coding.
(2/5/09) DME Provider Manual DME Provider Specific Manual
Revision Date: 2/5/09
Section Revised: 8.14
Updated to include the 2009 HCPC supply code, A6545.
(1/23/09) Pharmacy Billing Manual Pharmacy Billing Manual
Revision Date: 1/23/09
Section Revised: 2.3.2
Updates have been made to the NCPDP layouts. The updates are effective 3/2/09.
(1/8/09) Practitioner Provider Manual Practitioner Provider Manual
Revision Date 1/08/09
Sections Revised: 1.11.8.3 and 29.0
Updated the location to access specific criteria for prior authorization.
(1/8/09) Pharmacy Provider Specific Manual Pharmacy Provider Specific Manual
Revision Date: 1/8/09
Section Revised: 3.3.3 and 11.0
Updated the location to access specific criteria for prior authorization.
(12/9/08) Home Health Provider Manual Home Health Provider Manual
Revision Date 12/9/08
Sections Revised 6.1.9
Clarification made to early postpartum dishcharge in-home assessment.
(12/5/08) Long Term Care Provider Specific Manual Long Term Care Provider Specific Manual
Revision Date 12/5/08
Sections Revised 12.0
Added Nursing Home Responsibility section.
(11/11/08) General Policy Manual General Policy Manual
Revision Date 11/11/08
Sections Revised 4.1.3
Expanded the definition of whom is expected to bill for TPL co-pays.
(10/29/08) DME Provider Manual DME Provider Specific Manual
Revision Date: 10/24/08
Sections Revised: 5.11 and 8.6
Added sizing definition for incontinence underpads. Deleted prohibition on coverage of pull-up disposable training pants as pediatric and youth pull-on incontinence products are now covered and reimbursed at the same rate as the corresponding size brief/diaper code.
Added pediatric and youth pull-on incontinence product codes and clarified incontinence product three month limits.
(10/16/08) Hospice Provider Specific Manual Hospice Provider Specific Manual
Revision Date: 10/16/08
Section Revised: 9.0
Clarified the 10/8/08 revision of section 9.0 revenue codes.
(10/15/08) Hospice Provider Specific Manual Hospice Provider Specific Manual
Revision Date: 10/8/08
Section Revised: 9.2
Changed revenue code on Hospice service - Other
(10/10/08) General Policy Manual General Policy Manual
Revision Date 9/26/08 and 10/1/08
Sections Revised 8.1 and 4.4
PA Request Form - Updated Prior Authorization Request Form; Added to Covered Medicaid Services
(10/10/08) Practitioner Provider Manual Practitioner Provider Manual
Revision Date 10/07/08
Sections Revised: 30.0 Appendix O
Added wording to the Periodicity schedule regarding number of visits for early childhood years.
(9/18/08) Pharmacy Provider Specific Manual Pharmacy Provider Specific Manual
Revision Date: 9/18/08
Section Revised: Manual Heading, 11.66 and 11.67
Removed obsolete numbering. Authorization forms have been added for Leukotriene Receptor Antagonists and Inhaled Glucocorticoid/Beta-Agonist Combination.
(9/18/08) Practitioner Provider Manual Practitioner Provider Manual
Revision Date 9/18/08
Sections Revised: Manual Heading, 29.64 and 29.65
Removed obsolete numbering. Authorization forms have been added for Leukotriene Receptor Antagonists and Inhaled Glucocorticoid/Beta-Agonist Combination.
(8/29/08) General Policy Manual General Policy Manual
Revision Date 8/29/08
Sections Revised 8.1, 2.3.5.2.2, and 20.2
PA Request Form - Updated Prior Authorization Request Form; Removed the following wording from 2.3.5.2.2 that states "Magnetic Resonance Imaging (MRI)"; Added fax number for Robscott building
(8/29/08) DME Provider Manual DME Provider Specific Manual
Revision Date: 8/29/08
Sections Revised: 9.0
Updated Medicade Certificate of Medical Necessity
(8/15/08) Hospice Provider Specific Manual Hospice Provider Specific Manual
Revision Date: 8/15/08
Section Revised: 7.1.1, 7.1.1.1, 7.1.2, 7.1.3.2
Clarification of contact addresses and contact information under Hospice Notification.
(8/18/08) Pharmacy Provider Specific Manual Pharmacy Provider Specific Manual
Revision Date: 8/14/08 and 9/1/08
Section Revised: 2.1 and 6.0
Update to correct the wording associated with the listed publication examples. Added Cough and cold, oral and diabetes supplies to the PDL.
(8/18/08) Practitioner Provider Manual Practitioner Provider Manual
Revision Date 8/14/08 and 9/1/08
Sections Revised: 1.11 and 10.0
Update to correct the wording associated with the listed publication examples. Added Cough and cold, oral and diabetes supplies to the PDL.
(8/6/08) DME Provider Manual DME Provider Specific Manual
Revision Date: 8/6/08
Sections Revised: 5.11 and 8.6
Clarification of incontinence product usage and reimbursement and code table updates.
(7/31/08) General Policy Manual General Policy Manual
Revision Date 7/31/08
Sections Revised 2.3.4 and 6.0
Added Diamond State Partners Behavioral Health Benefit Prior Authorization directives and language is being added to clarify provider appeal policy.
(7/22/08) Practitioner Provider Manual Practitioner Provider Manual
Revision Date: 7/22/08
Section Revised: 1.11 and 1.2
DMMA coverage for FDA approved indications and clarification of the reporting requirement of the National Drug Code (NDC).
(7/22/08) Pharmacy Provider Specific Manual Pharmacy Provider Specific Manual
Revision Date: 7/22/08
Section Revised: 1.1 and 2.1
MMA coverage for FDA approved indications and reversed prescription requirements.
(7/17/08) General Policy Manual General Policy Manual
Revision Date 7/17/08
Sections Revised 12.1
Added additional covered procedure code, J7302.
(7/17/08) Inpatient Hospital Provider Policy Manual General Policy Manual
Revision Date 7/17/08
Sections Revised 3.4
Updated manual to reflect agency policy regarding reimbursement occurrence with valid Medical Assistance eligibility.
(7/7/08) General Policy Manual General Policy Manual
Revision Date 7/7/08
Sections Revised 1.31
Added reimbursement guidance for the Delaware Cancer Treatment Program.
(7/3/08) Inpatient Hospital Provider Policy Manual General Policy Manual
Revision Date 7/3/08
Sections Revised 2.8.2, 2.8.3 and 2.4.5, 2.5
Updated manual to reflect agency policy regarding reimbursement occurrence with valid Medical Assistance eligibility and renumbered section. Updated policy to reflect the proper budget epilogue reference.
(6/20/08) DME Provider Manual DME Provider Specific Manual
Revision Date: 6/20/08
Sections Revised: 8.9 and 5.1.3
Corrected the Dialysis Supplies heading. Changed the abbreviated definition of modifier BO to the full definition.
(06/12/08) FQHC Provider Manual FQHC Provider Manual
Revision Date: 6/12/08
Sections Revised: 2.2 and 3.1
Adjusted the CFR citation. Expanded upon "medical encounter" definition as per CFR.
(07/1/08) UB-04 Billing UB04 Billing Manual
Revision Date: 7/1/08
Section Revised: 3.1
Added information for billing HCPCS Drug Codes on Outpatient claims
(6/3/08) DME Provider Manual DME Provider Specific Manual
Revision Date: 6/3/08
Section Revised 1.2, 5.1.3, 8.1, and 8.16
Added wording to oral nutrition authorization request. Changes made to the fee schedule and pricing for glucose monitors and supplies effective 10/01/2006.

These documents require Adobe® Acrobat® ReaderTM. Select this link to download the latest version.
For a text only Adobe®Acrobat® ReaderTM.Select this link to download the alternate version.