DE Medicaid - What's New

5010 D.0 Information

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
(05/14/2013)	Client Refill Flyer	advising clients to refill prescriptions early during system downtime.
(05/13/2013)	General Billing Manual	General Billing Manual Revision Date: 4/2/2013 Section revised: 1.3 – Effective July 1, 2013 the cost for reprinting a remittance advice is $25.00. Section 1.4 – Added information about electronic remittance advices and electronic funds transfer payments. Section 5.0 – Updated the information on obtaining forms Section 6.0 – Updated the requirement for electronic billing.
(4/1/2013)	Dental Provider Specific Manual	Dental Specific Policy Manual Revision Date: 4/1/2013 Sections Revised: 8.0 Updated fees in dental fee schedule effective 04/01/2013.
(2/25/2013)	School-Based Health Services Provider Specific Manual	School-Based Health Services Provider Specific Manual Revision Date: 2/25/2013 Section Revised: 4.6.2 Update and clarification in reference to general services limitations. And 4.6.3 – Revised language to comply with CMS regulations and NCCI edits.
(2/25/2013)	Ambulance Provider Specific Manual	Ambulance Provider Specific Policy Manual Revision Date: 2/25/2013 Section Revised: 6.0 Added additional language for codes A0426 and A0428 as they are no longer in use after 9/30/2002.
(02/21/2013)	General Policy Manual	General Policy Manual Revision Date: 2/8/2013 Section revised: 2.1.9.1.1 Deleted reference to Prescribed Pediatric Care (PPEC) as categorically eligible.
(02/01/2013)	General Policy Manual	General Policy Manual Revision Date: 1/15/2013 Sections Revised: 12.1 and 12.2 – Added reference “(For dates of service through 12/31/2012)” for code J1055. Adding code J1050 to section 12.2.
(01/24/2013)	DME Policy Provider Specific Manual	DME Policy Provider Specific Manual Revision Date: 1/15/2013 Sections Revised: 8.5 – Adding code A4435* to section 8.5 and 8.14 – Deleted reference to “pad” and replaced with “sterile”, due to revised descriptions for procedure codes A6021-A6023
(01/03/2013)	Dental Provider Specific Manual	Dental Specific Policy Manual Revision Date: 1/2/2013 Section Revised: 8.0 Updated Appendix A with the 2012/2013 Codes and coverage guidelines
(12/21/2012)	Dental Provider Specific Manual	Dental Specific Policy Manual Revision Date: 12/21/2012 Sections Revised: 4.0 Added section 4.1.3.2 for Billing Medicaid Clients with Third Party Dental coverage and Section 5.0, Added 5.1.6 for Coordination of Dental PA’s and Third Party coverage . Effective 1/2/2013
(12/20/12)	VFC Rate Increase for 2013 and 2014	Primary Care and VFC Rate Increase for 2013 and 2014 Attention All providers: Under the provisions of the Affordable Care Act, state Medicaid Programs and their Managed Care Organizations must pay physicians who are board certified in the primary specialty of family medicine, general internal medicine, pediatric medicine or a subspecialty of the these designations at the Medicare Part B fee schedule rates in effect for 2013 and 2014 for certain CPT Evaluation & Management Codes and for VFC Administration Fees. Please click the link for more information on Primary Care and VFC Rate Increase for 2013 and 2014.
(12/10/12)	New VFC Requirements	New VFC Requirements Manual Delaware’s VFC Program recently received the latest version of CDC’s VFC Operations Guide. The VFC Operations Guide provides guidance to State and Local Immunization Programs to ensure compliance with VFC Program requirements. There are several changes Delaware VFC providers should be aware of regarding the VFC requirements. In 2013 Delaware’s VFC Program will begin to implement the new requirements.
(11/09/12)	Pharmacy Provider Specific Manual	Pharmacy Provider Specific Manual Revision Date: 11/9/2012 Sections Revised: 1.2, Replaced section 1.2.2.2 and added new subparagraphs for Language added to specify requirements for validating the receipt of medication by the patient or patient’s representative.
(11/01/12)	Prescribed Pediatric Extended Care Policy Provider Specific Manual	Prescribed Pediatric Extended Care Policy Provider Specific Manual Revision Date: 11/1/2012 Section Revised: 1.2, Added a new paragraph at 1.2.8 to address limited services where parent is searching for employment, effective 4/15/10.
(10/18/12)	Pharmacy Provider Specific Manual	Pharmacy Provider Specific Manual Revision Date: 10/16/2012 Sections Revised: 4.1.7, 4.1.7.1 and 4.1.7.2 New language and sections added clarifying that prescriptions may not be split into multiple prescriptions and dispensed. Revision Date: 10/18/2012 Section Revised: 3.4.2.3 Change in coverage of quantity and time frame.
(10/2/12)	Clinic Provider Policy Specific Manual	Clinic Provider Policy Specific Manual Revision Date: 10/2/2012 Sections Revised: 1.0, 3.1, 4.6, 4.10, 6.0, 10.10 and 10.17 Revised to update Clinic Provider Overview, Service Provider listing, Clinic definition, Clinic reimbursement methodology, and create new section for School-Base Wellness Centers.
(9/13/12)	Dental Provider Specific Manual	Dental Provider Specific Manual Revision Date: 9/13/2012 Sections Revised: 8.0 Sealants Age 3-6 and Medicaid Prior Authorization Request- removal of prior authorization forms for Interceptive Orthodontics and Oral Surgery as Part of Orthodontic Treatment Plan.
(8/14/12)	Pharmacy Provider Specific Manual	Pharmacy Provider Specific Manual Revision Date: 8/14/2012 Sections Revised: 2.1.2.1 New section added regarding documentation for phone in prescriptions.
(8/14/12)	DME Policy Provider Specific Manual	DME Policy Provider Specific Manual Revision Date: 8/14/2012 Section Revised: 8.6 Updated the quantity limits for code A4604.
(8/9/12)	Home Health Provider Manual	Home Health Provider Manual Revision Date 8/9/2012 Section revised: 5.2.3 Added provider type to list of practitioners who may perform a face-to-face encounter.
(8/07/12)	Dental Provider Specific Manual	Dental Provider Specific Manual Revision Date: 8/07/2012 Section Revised: 5.0 Updated Prior Authorization & 8.0 Coverage Guidelines.
(8/02/12)	Dental Provider Specific Manual	Dental Provider Specific Manual Revision Date: 8/02/2012 Sections Revised: 8.0 Updated rate information.
(7/30/12)	Dental Provider Specific Manual	Dental Provider Specific Manual Revision Date: 7/30/2012 Sections Revised: 2.0 Updated eligibility information, 4.0 Updated section on obtaining patient history and 5.0 Updated prior authorization information.
(6/21/12)	General Policy Manual	General Policy Manual Revision Date: 6/21/2012 Sections Revised: 8.7, 8.8, 8.9, and 8.10 Starting July 1, 2012 all Diamond State Partners Behavioral Health authorizations will be sent to Attention DMMA at fax number 302-255-4481.
(6/20/12)	Pharmacy Billing Manual	Pharmacy Billing Manual Revision Date: 6/11/12 Sections Revised: 2.6 – Updated the contact information for transitional enrollment for Part D. 4.0 Updated the DMMA Tamper-Resistant Prescription Pad Policy.
(6/20/12)	General Policy Manual	General Policy Manual Revision Date: 6/11/12 Sections Revised: 1.6.5 Added wording and guidance regarding the prohibition on payment for provider-preventable conditions, effective July 1, 2011.
(6/20/12)	Dental Provider Specific Manual	Dental Provider Specific Manual Revision Date: 5/21/2012 Sections Revised: 8.0, 9.0 and 10.0 Clarification made to the Orthodontic Scoring Index Guidelines located in the Dental Prior Authorization Forms Section of the DMAP website. Revision Date: 6/11/2012 Sections Revised: 3.2 Updated the Orthodontic Services section, Section 4.1 Updated the instructions for billing a Supernumerary tooth.
(5/21/12)	General Policy Manual	General Policy Manual Revision Date: 5/21/12 Sections Revised: 1.13 Based on section 6505 of the Affordable Care Act added wording addressing payment to providers. Medicaid will not make payments to any out of country financial institutions.
(5/10/12)	Pharmacy Billing Manual	Pharmacy Billing Manual Revision Date: 5/10/12 Section Revised: 2.1, 2.4, 3.0 Updated the completion of the Pharmacy Claim Form - instructions for completion section. Appendix A - NCPDP Other Coverage Codes removed. Updated text including NCPDP Version 5.1 to Version D.Ø.
(4/26/12)	Pharmacy Provider Specific Manual	Pharmacy Provider Specific Manual Revision Date: 4/26/12 Sections Revised: 3.7 New section added regarding our policy on drug shortage.
(4/26/12)	Practitioner Provider Specific Manual	Practitioner Provider Specific Manual Revision Date: 4/26/12 Sections Revised: 1.11.8.3 Removed obsolete wording.
(4/20/12)	Dental Provider Specific Manual	Dental Provider Specific Manual Revision Date: 4/20/12 Sections Revised: 8.0 Wording clarifications made to the dental fee schedule (Codes: D5120, D5211, D5212, D5213, D5214, D5225, D5226, and D6211) to support additional detailed descriptions.
(4/11/12)	General Policy Manual	General Policy Manual Revision Date: 4/11/12 Sections Revised: 1.31, 2.0, 3.0 and 10.0 Updated policy to reflect, effective 04/01/2012 additional Medicaid populations now served through a Managed Care Organization (MCO).
(4/16/12)	Ambulatory Surgical Center Provider Specific Manual	Ambulatory Surgical Center Provider Policy Specific Manual Revision Date: 4/16/12 Sections Revised: Overview Removed obsolete number.
(4/16/12)	AIDS Waiver Provider Specific Manual	AIDS Waiver Provider Specific Manual Revision Date: 4/16/12 Sections Revised: Above the Overview Updated policy to reflect, effective 4/01/2012 additional Medicaid populations now served through a Managed Care Organization (MCO).
(4/16/12)	Elderly and Disabled Waiver Provider Policy Manual	Elderly and Disabled Waiver Provider Policy Manual Revision Date: 4/16/12 Sections Revised: 1.0 Updated policy to reflect, effective 4/01/2012 additional Medicaid populations now served through a Managed Care Organization (MCO).
(4/16/12)	HCBS/DD Waiver Manual	HCBS/DD Waiver Manual Revision Date: 4/16/12 Sections Revised: Above the Overview Updated policy to reflect, effective 4/01/2012 additional Medicaid populations now served through a Managed Care Organization (MCO).
(4/16/12)	Optician Policy Provider Specific Manual	Optician Policy Provider Specific Manual Revision Date: 4/16/12 Sections Revised: 1.1 Updated policy to reflect, effective 4/01/2012 additional Medicaid populations now served through a Managed Care Organization (MCO).
(4/16/12)	Part C Birth to Three Provider Policy Specific Manual	Part C Birth to Three Provider Policy Specific Manual Revision Date: 4/16/12 Sections Revised: 1.1 Updated policy to reflect, effective 4/01/2012 additional Medicaid populations now served through a Managed Care Organization (MCO).
(4/9/12)	Dental Provider Specific Manual	Dental Provider Specific Manual Revision Date: 4/9/12 Sections Revised: 8.0 Updated fees in dental fee schedule effective 04/01/2012.
(3/27/12)	Hospice Provider Specific Manual	Hospice Provider Specific Manual Revision Date: 3/27/12 Section Revised: Above the hospice overview Correction made to the revision table for the 04/02/2012 hospice manual update.
(3/27/12)	Hospice Provider Specific Manual	Hospice Provider Specific Manual Revision Date: 3/27/12 Section Revised: 7.1.1.1 Updated policy to reflect that effective 04/01/2012 additional Medicaid populations will now be serviced through a Managed Care Organization (MCO).
(3/16/12)	Practitioner Provider Specific Manual	Practitioner Provider Specific Manual Revision Date: 3/16/12 Sections Revised: 5.5 Update to the definition of “Time Units”.
(3/7/12)	Dental Provider Specific Manual	Dental Provider Specific Manual Revision Date: 3/7/12 Sections Revised: 1.0 and 8.0 Updated policy to support the new DMAP Dental Fee schedule.
(3/5/12)	Elderly and Disabled Waiver Provider Policy Manual	Elderly and Disabled Waiver Provider Policy Manual Revision Date: 3/5/12 Sections Revised: 6.1, 8.1 6.1 - Added assisted living "bed hold" policy. 8.1 - Updated procedure code table to reflect a missing code used for respite care, T1005.
(2/21/12)	General Policy Manual	General Policy Manual Revision Date: 2/21/12 Sections Revised: 1.23, 12.1, 17.0 1.23 - Updated wording to reflect the Affordable Care Act section 1902 prohibition on Qualified Medicare Beneficiary (QMB) "balanced billing" for Medicare cost sharing. 12.1 - Newly added procedure code, J7300. Section 17.0 - Update of the childhood and adolescent vaccination and catch-up immunization schedule for 2012.
(2/21/12)	Dental Provider Specific Manual	Dental Provider Specific Manual Revision Date: 2/21/12 Sections Revised: 4.2 Added anesthesia guidance.
(2/8/12)	DME Policy Provider Specific Manual	DME Policy Provider Specific Manual Revision Date: 2/8/12 Section Revised: 8.0 Added additional supplies and corresponding codes (A5056, A5057, and A9272).
(2/7/12)	Outpatient Hospital Provider Manual	Outpatient Hospital Provider Manual Revision Date: 2/7/12 Sections Revised: 3.2 Changed dental service section to reflect proper claim fields for billing accuracy.
(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.

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