What's New Archives

Date	Link	Description
(4/18/08)	UB04 Billing Manual	UB04 Billing Manual Revision Date: 4/18/08 Section Revised: Appendix C Change to status code 05 and add a new status code 70.
(4/11/08)	Clinic Provider Specific Manual	Clinic Provider Specific Manual Revision Date: 4/11/08 Section Revised: 4.8.2, 5.1.1 and 10.8 Information on dental services has been updated.
(4/9/08)	Pharmacy Provider Specific Manual	Pharmacy Provider Specific Manual Revision Date: 4/9/08 Section Revised: 11.64, 11.65, 11.8, 11.16, 11.17, 11.28, 11.30, and 11.43 Authorization forms have been added for Maraviorac (Selzentry®) and Pregabalin (Lyrica®) and the criteria forms for 5-HT3 Receptor Antagonists, Oxycodone, Fentanyl Transdermal, CNS Stimulants, Levalbuterol HCI (Xopenex®), and Quantity Limit Overrides have been updated.
(4/9/08)	Practitioner Provider Manual	Practitioner Provider Manual Revision Date 4/9/08 Section Revised 29.62, 29.63, 29.8, 29.16, 29.17, 29.27, 29.29, and 29.42 Authorization forms have been added for Maraviorac (Selzentry®) and Pregabalin (Lyrica®) and the criteria forms for 5-HT3 Receptor Antagonists, Oxycodone, Fentanyl Transdermal, CNS Stimulants, Levalbuterol HCI (Xopenex®), and Quantity Limit Overrides have been updated.
(2/8/08)	UB04 Billing Manual	UB04 Billing Manual Revision Date: 2/8/08 Section Revised 2.5 Added instructions for billing inpatient services for recipients with no Part A coverage or exhausted Part A coverage.
(1/18/08)	General Policy Manual	General Policy Manual Revision Date 1/18/08 Sections Revised 17.0, 17.1, 17.2, 17.3, 17.4, 17.5. 17.6, 17.7, 17.8 Update of the childhood and adolescent vaccination schedule for 2008 and addition of catch-up immunization schedules.
(1/4/08)	DME Provider Manual	DME Provider Specific Manual Revision Date: 1/4/08 Section Revised 8.1, 8.8, 8.10, 8.15 and 8.16 Sections in Appendix A are being updated to include 2008 HCPCS supply codes; the description for code A4216 from 2007 HCPCS is being revised and code A4635 is being added back as previously deleted in error.
(12/26/07)	Practitioner Provider Manual	Practitioner Provider Manual Revision Date 12/21/07 Section Revised 10.1 A new procedure for billing allergy injections is effective for dates of service January 1, 2008 and after.
(12/14/07)	Acquired Brain Injury Medicaid Waiver Program Provider Specific Policy Manual	Acquired Brain Injury Medicaid Waiver Program Provider Specific Policy Manual Revision Date 12/14/07 Sections Revised: 6.0, 7.1, and 7.2 Procedure and contact information has been added.
(12/14/07)	General Policy Manual	General Policy Manual Revision Date 12/14/07 Sections Revised 1.21.1.3.1 and 2.1.9.1.1.2 Updated policy to reflect Acquired Brain Injury (ABI) Waivers relation to prior authorization and DSHP.
(11/26/07)	Pharmacy Billing Manual	Pharmacy Billing Manual Revision Date: 11/26/07 Section Revised: 2.4 Clarification has been made to the billing instructions for paper claims.
(11/05/07)	General Policy Manual	General Policy Manual Revision Date 12/1/07 Sections Revised 1.32.5, 1.32.5.1, 1.32.5.2, 1.32.5.3, and 1.32.5.4 Added wording introducing the Acquired Brain Injury (ABI) Medicaid Waiver Program
(11/05/07)	General Policy Manual	General Policy Manual Revision Date 10/29/07 Sections Revised 1.6.3 Added directives regarding the Deficit Reduction Act initiative entitled .Employee Education About False Claims Recovery.
(11/05/07)	General Policy Manual	General Policy Manual Revision Date 7/01/07 Sections Revised 1.21.1.2, 1.21.1.3, 2.1.10.2.25, 2.1.11.1.14 and 2.1.11.2.7 Update to reflect full coverage of PDN services under managed care effective 7/1 /07.
(07/01/07)	Private Duty Nursing Manual	Private Duty Nursing Manual Revision Date: 7/01/07 Sections Revised 1.0 and 1.1.1 Update to reflect full coverage of PDN services under managed care effective 7/1/07.
(12/01/07)	Acquired Brain Injury Medicaid Waiver Program Provider Specific Policy Manual	Acquired Brain Injury Medicaid Waiver Program Provider Specific Policy Manual Revision Date 12/01/07 Sections Revised: All This is a new provider manual for a new program.
(10/22/07)	General Policy Manual	General Policy Manual Revision Date 10/22/07 Sections Revised 1.19.2.3 Update regarding timely filing overrides
(10/16/07)	CMS-1500 Billing Manual	CMS-1500 Billing Manual Revision Date: 10/16/07 Sections revised 2.3 Diagnosis code directives simplified.
(10/10/07)	UB04 Billing Manual	UB04 Billing Manual Revision Date: 10/10/07 Sections revised 2.2 and 2.3 Updates to the UB04 completion table and procedures.
(10/05/07)	General Policy Manual	General Policy Manual Revision Date 10/05/07 Sections Revised 1.20, 1.28, 2.1 and 2.2 Update to reflect dental coverage for DHCP recipients effective 10/1/06. Sections Revised 1.6, 1.10, 1.10.4 and 19.0 Added newly mandated tamper resistant prescription pad policy and new appendix.
(10/04/07)	Pharmacy Provider Specific Manual	Pharmacy Provider Specific Manual Revision Date: 10/04/07 Section Revised: 2.1.2 Added newly mandated tamper resistant prescription pad policy.
(10/04/07)	Practitioner Provider Manual	Practitioner Provider Manual Revision Date: 10/04/07 Section Revised: 1.11.1.5 Added newly mandated tamper resistant prescription pad policy.
(10/03/07)	Pharmacy Billing Manual	Pharmacy Billing Manual Revision Date: 10/03/07 Section Revised: Appendix B Added newly mandated tamper resistant prescription pad legitimacy requirements.
(09/21/2007)	Inpatient Hospital Manual	Inpatient Hospital Manual Revision Date: 09/21/07 Sections Revised: 2.8.2.4 Removed entire section.
(09/04/2007)	Inpatient Hospital Manual	Inpatient Hospital Manual Revision Date: 09/04/07 Sections Revised: 2.2.1.1 and 2.2.1.2 Clarification of review criteria and removal of reference to diff erent facilities.
(09/04/07)	DME Provider Manual	DME Provider Specific Manual Revision Date: 09/04/07 Section Revised 5.16.1 Removed incorrect prior authorization wording
(08/31/07)	CMS-1500 Billing Manual	CMS-1500 Billing Manual Revision Date: 08/30/07 Sections Revised 2.2, 2.3, 2.5, 2.6 and 2.7 Clarification has been made to the billing instructions.
(08/31/07)	UB04 Billing Manual	UB04 Billing Manual Revision Date: 08/30/07 Sections revised 2.2, 2.3, 2.5, 2.6, 2.7 and 2.10 Clarification has been made to the billing instructions.
(08/31/07)	Pharmacy Billing Manual	Pharmacy Billing Manual Revision Date: 08/30/07 Sections revised 2.4 and 2.6.1 Clarification has been made to the billing instructions.
(08/31/07)	Dental Billing Manual	Dental Billing Manual Revision Date: 08/30/07 Sections Revised 2.2, 2.3 and 2.5 Clarification has been made to the billing instructions.
(08/09/07)	DME Provider Manual	DME Provider Specific Manual Revision Date: 08/09/07 Sections Revised 10.1 & 10.2 Combined multiple Renal Supplement forms.
(08/06/07)	General Policy Manual	General Policy Manual Revision Date 8/06/07 Section Revised 4.4 Update to remove obsolete QI-2 data.
(08/07)	General Policy Manual	General Policy Manual Revision Date 8/07 Section Revised 1.31.6 The eligibility period for the Delaware Cancer Treatment Program has been changed to 24 months.
(07/24/07)	General Policy Manual	General Policy Manual Revision Date 7/24/07 Section Revised 9.0 A list of the Division of Medicaid and Medical Assistance programs was added.
(07/19/07)	Independent Laboratory Provider Specific Manual	Independent Laboratory Provider Specific Manual Revision Date 7/19/07 Section Revised 7.8 Updated hematology billing instructions.
(07/18/07)	General Policy Manual	General Policy Manual Revision Date 7/18/07 Section Revised 9.0 The DMMA mission statement in Appendix D has been revised.
(06/25/07)	Practitioner Provider Specific Policy Manual	Practitioner Provider Specific Manual Revision Date 6/25/07 Sections Revised 29.16 and 29.17 The criteria forms for Oxycodone and Morphine Sustained Release Products and Fentanyl Transdermal have been updated.
(06/25/07)	Pharmacy Provider Specific Policy Manual	Pharmacy Provider Specific Manual Revision Date: 6/25/07 Sections Revised 11.16 and 11.17 The criteria for Oxycodone and Morphine Sustained Release Products and Fentanyl Transdermal have been updated.
(06/22/07)	Pharmacy Billing	Pharmacy Billing Manual &nb sp; Revision Date: 6/22/07 Sections Revised 2.2.7, 2.3.2, 2.4 and 2.6 Clarification for billing after primary insurance. Update to data field 110-AK and clarification for billing compounds.
(06/05/07)	Private Duty Nursing Manual	Private Duty Nursing Manual Revision Date: 6/05/07 Section Revised 5.3.3 Update to reflect proper wording.
(05/31/07)	Practitioner Provider Specific Policy Manual	Practitioner Provider Specific Manual Revision Date 5/31/07 Sections Revised 20.0, 29.24, 29.48, 29.56, 29.60 and 29.61 Glucose monitors have been added to the inclusion list. Sections 29.24, 29.48 and 29.56 have been updated. Authorization forms have been added for Lubiprostone (Amitiza\256) and Hepatitis C Agents.
(05/31/07)	Pharmacy Provider Specific Policy Manual	Pharmacy Provider Specific Manual Revision Date 5/31/07 Sections Revised 6.0, 11.25, 11.49, 11.58, 11.62 and 11.63 Glucose monitors have been added to the inclusion list. Sections 11.25, 11.49 and 11.58 have been updated. Authorization forms have been added for Lubiprostone (Amitiza\256) and Hepatitis C Agents.
(05/25/07)	DMMA RFI for diabetes strips and syringes	DMMA RFI for diabetes strips and syringes
(05/14/07)	General Billing Manual	General Billing Manual Revision Date 5/14/07 Section Revised 1.3 Adding additional information regarding requests for copies of remittance advices and checks.
(05/08/07)	Extended Pregnancy Policy Provider Specific Manual	Extended Pregnancy Policy Provider Specific Manual Revision Date 5/8/07 Section Revised 7.0 Updated S9127 Procedure Code description
(05/03/07)	DME Provider Manual	DME Provider Specific Manual Revision Date: 5/03/07 Sections Revised: 3.1.7 Updated fax phone number to (302) 255-4481
(04/23/07)	General Policy Manual	General Policy Manual Revision Date: 4/23/07 Sections Revised 8.1, 8.8, 8.9, 14.0, 15.0, 16.0, 18.2 and added 17.3 and 17.4 NPI wording updates and update to Childhood Vaccination schedule and new sections 17.3 and 17.4 reflect new division by age.
(04/03/07)	Pharmacy Provider Specific Policy Manual	Pharmacy Provider Specific Manual Revision Date 04/03/07 Sections Revised 11.59, 11.60 and 11.61. Authorization forms have been added for Methadone (Methadose\256), Naltrexone hydrochloride (Vivitrol\231) and Pimecrolimus (Elidel\256) and Tacrolimus (Protopic\256).
(04/03/07)	Practitioner Provider Specific Policy Manual	Practitioner Provider Specific Manual Revision Date 04/03/07 Sections Revised 29.57, 29.58 and 29.59 Authorization forms for Methadone (Methadose\256), Naltrexone Hydrochloride (Vivitrol\231), and Pimecrolimus (Elidel\256) and Tacrolimus (Protopic\256) have been added.
(03/08/07)	Diagnosis Codes Flyer	Pharmacists: When a diagnosis code is provided on a prescription, please include it on the claim transaction to Delaware Medicaid & Medical Assistance (DMMA). This may eliminate the need for a phone call or form to authorize coverage. Note: Only include a diagnosis code if the practitioner included it on the prescription.
(03/05/07)	Flyer Stakeholder Letter	Kick-off Meeting for Advancing Excellence in America's Nursing Homes on March 7 and March 8
(01/22/07)	DME Provider Manual	DME Provider Specific Manual Revision Date: 1/22/07 Sections Revised: 3.5.7 Clarification of payment of equipment rental fees and Appendix A Several sections in Appendix A are being updated to include 2007 HCPCS supply codes
(01/19/07)	CMS-1500 Billing	CMS-1500 - Billing Manual - Effective 3/10/07 - Section 2.3 Complete revision to reflect changes made to the CMS -1500 (revision 08/05) Claim Form on Instructions for Completion.
(01/19/07)	UB-04 Billing	UB04 Billing Manual - Effective 3/10/07 - Section 2.3 Complete revision to reflect changes made to the UB-04 Claim Form on Instructions for Completion.
(01/19/07)	Pharmacy Billing	Pharmacy Billing Manual - Effective 3/10/07 - Sections 2.2 and 2.4 Added instructions for the prescriber id field of the paper pharmacy claim form to include the National Provider Identifier (NPI). Effective 3/25/07 - Sections 2.3.1 and 2.3.2 Updated the NCPDP 5.1 layouts for NPI billing.
(01/19/07)	Dental Billing	Dental Billing Manual - Effective 3/10/07 - Section 2.3 Update to billing instructions to reflect changes related to NPI
(01/19/07)	Private Duty Nursing Manual	Private Duty Nursing Manual Revision Date: 1/19/07 Sections Revised: 1.0, 1.1, 1.1.4, 4.1.1, 4.2, 4.2.1, 5.1.2, 5.2.3, 5.2.4, 5.2.6 and 5.3.4 Additional changes made to reflect 03/10/05 legislative changes.
(01/03/07)	General Policy Manual	General Policy Manual Revision Date: 1/3/07 Sections Revised 2.3 Diamond State Partner prior authorization update
(11/28/06)	Practitioner Provider Specific Policy Manual	Practitioner Provider Specific Manual Revision Date 11/28/06 Section Revised 29.19, 29.55 and 29.56 Section 29.19 Authorization forms have been added for Insulin Human (Inhalation) Exubera\256 and (Sitagliptin phosphate) Januvia\231
(11/28/06)	Pharmacy Provider Specific Policy Manual	Pharmacy Provider Specific Manual Revision Date 11/28/06 Sections Revised 11.20, 11.57 and 11.58 Section 11.20 Authorization forms have been added for Insulin Human (Inhalation) Exubera\256 and (Sitagliptin phosphate) Januvia\231
(11/22/06)	General Policy Manual	General Policy Manual Revision Date: 11/22/06 Sections Revised: 1.21.11 and 1.21.11.1 Adding Sleep Studies/Polysomnography section to Services Requiring Prior Authorization.
(11/10/2006)	Pharmacy Provider Specific Policy Manual	Pharmacy Provider Specific Policy Manual Revision Date 11/8/06 Sections Revised: 11.2, 11.8, 11.12, 11.13, 11.15, 11.21, 11.22, 11.25, 11.27, 11.28, 11.30, 11.33, 11.45, 11.49, 11.54 and 11.56 Added clarification to existing prior authorization forms. Authorization form for Step Therapy (11.45) was removed and reserved for future use. Authorization form for Methylphenidate (DAYTRANA\231) was added.
(11/10/2006)	Practitioner Provider Specific Policy Manual	Practitioner Provider Specific Policy Manual Revision Date 11/8/06 Sections Revised: 29.2, 29.8, 29.12, 29.13, 29.15, 29.20, 29.21, 29.24, 29.26, 29.27, 29.29, 29.32, 29.44, 29.43 and 29.54 Added clarification to existing prior authorization forms. Authorization form for Step Therapy (29.44) was removed and reserved for future use. Authorization form for Methylphenidate (DAYTRANA\231) was added.
(10/30/06)	General Policy Manual	General Policy Manual Revision Date: 10/30/06 Section Revised: 1.29 Update and clarification made to transportation policy.
(10/25/06)	Pharmacy Billing Manual	Pharmacy Billing Manual Revision Date: 10/25/06 Sections Revised: 2.2 and Appendix A Added the option of providing a license number instead of a DEA number when applicable. Added language directing providers to bill Medicare Part B for covered medications or devices and clarified correct use of NCPDP coverage codes.
(09/27/2006)	DME Provider Manual	DME Provider Manual Revision Date: 9/22/06 Sections Revised: 5.1.3 & Appendix C Added documentation requirements and forms for coverage of renal supplements
(09/27/2006)	DME Provider Manual	DME Provider Manual Revision Date: 9/22/06 Sections Revised: Appendix B Changed the heading to Division of Medicaid and Medical Assistance and removed wording specific to enteral supplements
(09/26/2006)	Pharmacy Billing Manual	Pharmacy Billing Manual Revision Date: 9/26/06 Sections Revised: 2.2, 2.3.2, 2.4, 2.6, and 3.0 Adding clarification to existing policy
(09/20/2006)	General Policy Manual	General Policy Manual Revision Date: 9/19/06 Sections Revised: 1.27.3.2 Updatd the Delaware Prescription Assistance Program benefit amount based on Senate Bill #297, 143rd. General Assembly (signed into law on July 6, 2006)
(09/20/2006)	Ambulatory Surgical Center Provider Specific Manual	Ambulatory Surgical Center Provider Specific Manual Revision Date: 9/19/06 Sections Revised: 2.3 and 5.6 Added coverage and billing information for corneal tissue acquisition
(09/05/2006)	Pharmacy Provider Specific Manual	Pharmacy Provider Specific Manual Revision Date: 9/5/06 Sections Revised: 2.1.2, 3.1.1.3, 3.1.1.4, 3.3, 3.4, 3.5.2.1, 4.1.7, and 4.2.4.2.1 Adding clarification to existing policy
(08/30/2006)	DSP Directory	Diamond State Partners Provider Listing
(08/16/2006)	General Policy Manual	General Policy Manual Revision Date: 8/16/06 Sections Revised: 12.1, 12.2, Appendix G Removed procedure codes 58605 and 71020 from the Family Planning and Related Services Benefit Package based on guidance from CMS
(07/26/2006)	General Policy Manual	General Policy Manual Revision Date: 7/26/06 Sections Revised: 8.8, 8.9 Updated the Diamond State Partners Outpatient Medication Management and Outpatient Treatment Request forms.
(07/24/2006)	Citizenship Postcard	Citizenship Postcard detailing the proof of ID or citizenship required for Medicaid renewals and applications. It is also available in Spanish.
(07/14/2006)	General Policy Manual	General Policy Manual Revision Date: 7/14/06 Sections Revised: 3.2.1, 3.2.2, 3.3 Revised description of the Medical Assistance Card to include verbiage about the white version of the card.
(06/29/2006)	Inpatient Hospital Manual	Inpatient Hospital Manual Revision Date: 6/29/06 Revised Section: 4.1.3 Clarified coverage of inpatient psychiatric services for 18-21 year olds.
(06/27/2006)	UB-92 Billing Manual	UB-92 Billing Manual Revision Date: 6/26/06 Revised Sections: Appendix C Revised to include effective and end dates for each code. Also added codes 43, 64, 65 and 66.
(06/21/2006)	School-Based Health Services Manual	School Based Health Services Manual Revision Date: 6/21/06 Revised Sections: 4.2.2.4, 4.2.3.4, 4.2.4.4, 4.2.5.4, 4.3, 7.2.2 Revision of the time frame for completion of a progress note reflected throughout the manual.
(05/25/2006)	Pharmacy Billing	Pharmacy Billing Manual Revision Date: 5/25/06 Revised Section: 1.3 Modified the process for calculating co-payments.
(05/24/2006)	DSP Directory	Diamond State Partners Provider Listing
(05/16/2006)	Pharmacy Manual	Pharmacy Provider Specific Policy Manual Revision Date: 5/15/06 Sections Revised: 11.16, 11.17 Avinza has been added as a preferred long acting opioid.
(05/16/2006)	Practitioner Manual	Practitioner Provider Specific Policy Manual Revision Date: 5/15/06 Sections Revised: 29.16, 29.17 Avinza has been added as a preferred long acting opioid.
(04/11/2006)	Pharmacy Manual	Pharmacy Provider Specific Policy Manual Revision Date: 4/11/06 Sections Revised: 11.47, 11.52, 11.53 Removed the prior authorization forms for Eszopiclone, Ramelteon and Zolpidem. Section Revised: 11.43 Removed the Pharmacy Limitation for Sedatives/Hypnotics.
(04/11/2006)	Practitioner Manual	Practitioner Provider Specific Policy Manual Revision Date: 4/11/06 Sections Revised: 29.46, 29.51, 29.52 Removed the prior authorization forms for Eszopiclone, Ramelteon and Zolpidem. Section Revised: 29.42 Removed the Pharmacy Limitation for Sedatives/Hypnotics.
(03/21/2006)	UB92 Manual	UB92 Billing Manual Revision Date: 3/21/06 Section Revised: 2.3, Form Locator 4 Removed reference to claims containing more than 23 lines. Section Revised: 2.10 Added instructions for billing claims with over 23 lines.
(03/21/2006)	Pharmacy Provider Manual	Pharmacy Provider Specific Policy Manual Revision Date: 3/21/06 Section Revised: 3.5.8 Added policy regarding coverage of drugs to promote weight gain. Section Revised: 11.41 Replaced prior authorization form for Dronabinol with a prior authorization form for weight gain promoting agents. Section Revised: 11.11.1 The MedWatch Form has been moved from 11.12.1 to 11.11.1.
(03/21/2006)	Practitioner Provider Manual	Practitioner Provider Specific Policy Manual Revision Date: 3/21/06 Section Revised: 1.11.2.7 Added policy regarding coverage of drugs to promote weight gain. Section Revised: 29.40 Replaced prior authorization form for Dronabinol with a prior authorization form for weight gain promoting agents. Section Revised: 29.11.1 The MedWatch Form has been moved form 29.12.1 to 29.11.1.
(03/16/2006)	CMS Billing Manual	CMS 1500 Billing Manual Revision Date: 3/16/06 Section Revised: 2.6 Removed duplicative text.
(03/06/2006)	School-Based Services	School-Based Services Provider Specific Policy Manual Revision Date: 3/6/06 Section Revised: 2.5.3 Revision of the time frame for completion of a progress note.
(02/24/2006)	UB92 Billing Manual	UB92 Billing Manual Revision Date: 2/24/06 Section Revised: 2.3 Updated the instructions for completing Type of Bill.
(02/14/2006)	General Policy Manual	General Policy Manual Revision Date: 2/14/06 Section Revised: 1.21.10 Added policy regarding prior authorization of bariatric surgery.
(02/02/2006)	Inpatient Manual	Inpatient Hospital Provider Specific Policy Manual Revision Date: 2/2/06 Section Revised: 2.8.2.2 Revised the interim payment policy for high cost client cases.
(02/02/2006)	Pharmacy Manual	Pharmacy Provider Specific Policy Manual Revision Date: 2/2/06 Section Revised:4.1.4.3 Added clarification regarding pharmacy reimbursements.
(01/26/2006)	FSER Manual	Free Standing Emergency Room Provider Manual Revision Date: 1/26/06 Section Revised: All New Manual
(01/26/2006)	Home Health Manual	Home Health Provider Manual Revision Date: 1/26/06 Section Revised: 7.2.1 Revised to reflect address change for PAs. Section Revised: 7.2.2 Added reference to the PA form located in the General Policy Manual. Section Revised: 7.2.2.1-7.2.2.4 Deleted Section Revised: 7.2.3 Revised section Section Revised: 7.2.3-7.2.3.4 Renumbered sections to maintain consistency. Section Revised: 7.2.3.2 New section number and placement.
(01/24/2006)	Pharmacy Manual	Pharmacy Provider Specific Policy Manual Revision Date: 1/24/06 Section 11.55 Added a prior authorization from for Part D Override Requests.
(01/19/2006)	DME Manual	DME Provider Specific Policy Manual Revision Date 1/19/06 Section 8.0 Appendix A Medical and Surgical Supplies Corrected the definition of the following HCPCS codes: A4218, A4248, A4233, A4234, A4235, A4236, A4412, A5120, A6549.
(01/12/2006)	General Policy Manual	General Policy Manual Revision Date: 01/18/06 Section: 1.21 Added reference to the new DMMA prior Authorization Forms. Section: 1.21.1.2 Revised reference to section 2.3 for DSP required forms to reflect that the forms are now located in section 8.0. Section: 18.0 - Appendix M Revised section 18.0 for all DMMA PA forms. 18.1 is now PA Request for Related Expenses and 18.2 is the DMMA PA request form.
(01/12/2006)	EVS Manual	Electronic Verification System Manual Revision Date: 1/9/06 Section Revised: 2.12.3 Update DUR+ PA Criteria forms screen to show the addition of three new forms: Ramelteon (Rozerem\256), Zolpidem Controlled Release (Ambien CR\256) and Pramlintide Ac etate Injection (Symlin\256). Update to remove add/update capabilities for Enfuvirtide (Fuzeon\256).
(01/10/2006)	General Policy Manual	General Policy Manual Revision Date: 01/10/06 Sections Revised: 1.27 - 1.27.4.2 Revised and updated the DPAP policy to include the new Medicare Part D Prescription Drug Plan.
(01/04/2006)	DME Manual	DME Provider Specific Policy Manual Revision Date: 01/05/06 Sections Revised: 8.0 Appendix A \226 Medical and Surgical Supplies Deleted the following HCPCS codes: A4254, A5119, A5509, A5511 and A6551 Added the following HCPCS codes: A4218, A4233, A4234, A4235, A4236, A4363, A4411, A4412, A4604, A5120, A5512, A5513, A6457, A6513, A6530, A6531, A6532, A6533, A6534, A6535, A6536, A6537, A6538, A6539, A6540, A6541, A6542, A6543, A6544, A6549, A9275.
(12/28/2005)	DPAP AD	Delaware Prescription Assistance: 12/30/05 Newspaper article
(12/27/2005)	Contingency Postcard	Delaware Prescription Assistance: Important Information Regarding DPAP Benefits
(12/20/2005)	Clinic Provider	Clinic Provider Specific Policy Manual Revision Date: 12/20/05 Revised Sections: 10.0 Appendix B – HCPCS Procedure Codes, subsection 10.3 Tuberculosis Clinical Service Revised description of code 86580 and revised description of code 86585 per CPT 2006.
(12/20/2005)	AIDS Waiver Provider	AIDS Waiver Specific Policy Manual Revision Date: 12/20/05 Section Revised: Appendix B Replaced current HCPCS code and description 96100 with code 96101. Effective 1/1/2006.
(12/19/2005)	Pharmacy Provider	Pharmacy Provider Specific Policy Manual Revision Date: 12/19/05 Revised Sections: 4.2.4.2.1, 11.43 The diagnosis code associated with pregnancy has been updated. Albuterol has been added to the Request for Quantity Limitation Override form.
(12/19/2005)	Practitioner Provider	Practitioner Provider Specific Policy Manual Revision Date: 12/19/05 Revised Section: 29.427 Albuterol has been added to the Request for Quantity Limitation Override form.
(12/12/2005)	Pharmacy Billing	Pharmacy Billing Manual Revision Date: 12/13/05 Revised Sections: 1.3 and 2.2-2.7 Electronic and paper claim submission has changed for Medicare Part D. A new section has been created for Medicare Part D billing in section 2.6. The DMAC pricing inquiry worksheet has been moved to section 2.7
(12/05/2005)	FQHC Provider	FQHC Provider Specific Policy Manual Revision Date: 12/2/05 Revised Sections: All FQHC policy removed from Practitioner Provider Specific Policy Manual. FQHC Provider Specific Policy Manual created. Content remained unchanged.
(11/29/2005)	Practitioner Provider	Practitioner Provider Specific Policy Manual Revision Date: 11/23/05 Sections Revised: 29.51, 29.52, 29.53 Authorization forms have been added for Rozerem, Ambien CR and Symlin. Section Revised: 29.22 Removed the authorization form for Fuzeon. Section Revised: 29.27 The authorization form for CNS Stimulants and Atomoxetine has been updated to clarify the general requirements.
(11/29/2005)	Pharmacy Provider	Pharmacy Privider Specific Policy Manual Revision Date: 11/23/05 Sections Revised: 11.52, 11.53, 11.54 Authorization forms have been added for Rozerem, Ambien CR and Symlin. Section Revised: 11.23 Removed the authorization form for Fuzeon. Section Revised: 11.28 The authorization form for CNS Stimulants and Atomoxetine has been updated to clarify the general requirements.
(11/21/2005)	Inpatient Manual	Inpatient Hospital Provider Specific Policy Manual Revision Date: 11/21/05 Revised Section: 5.3 Changed heading title to clarify section. Revised Section: 5.3.2.1 Renamed Map-25. Now titled Comprehensive Medical Report. Revised Section: 12.0 Removed the Appendix F-Map 25 form. This form is provided by DMMA at the time of application. Titled section Reserved.
(11/21/2005)	Outpatient Manual	Outpatient Hospital Provider Specific Policy Manual Revision Date: 11/21/05 Revised Section: 5.2.1 Updated to reflect 4-digit revenue codes. Revised Section: 7.0 Removed Appendix A – Map 25. This form is provided by DMMA at the time of application. Renamed section Reserved
(11/21/2005)	Practitioner Manual	Practitioner Provider Specific Policy Manual Revision Date: 11/21/05 Revised Section: 1.8.2.3 Removed reference to “Map 25” and removed reference to Appendix A. Revised Section: 13.0 FQHC policy removed from Practitioner Provider Specific Policy Manual. FQHC Provider Specific Policy Manual created. Content Remained unchanged. Revised Section: 16.0 Removed Map 25 Comprehensive Medical Report form. This form is provided by DMMA at the time of application. Titled section Reserved.
(11/15/2005)	UB92 Manual	UB92 Billing Manual Revision Date: 11/14/05 Revised Section: Appendix C Appendix C has been updated to reflect the current patient status codes.
(11/04/2005)	Provider Manual	Practitioner Provider Specific Policy Manual Revision Date 11/04/05 Revised Sections: 1.0 Added bullet for Independent Certified Registered Nurse Anesthetists. Revised Sections: 1.5, Added:1.5.1, 1.5.1.1, 1.5.1.2, 1.5.1.3 and 1.5.1.4 Renamed section and added subsections to include services covered as part of other services. Revised Sections: 1.13.1 – 1.13.2.1 Reorganized to correct formatting. Revised Section: 5.0 Renamed section. Revised Sections: 5.1-5.6 Replaced “anesthesiologists” and “physician” with “anesthesiology provider”. Revised Sections: Added new section 5.7, 5.7.1, 5.7.1.1 and 5.7.2 Added sections to include policy for Independent Certified Registered Nurse Anesthetists. Revised Sections:30.1 and added 30.2 Named and numbered the periodicity schedule. Renumbered the section worded Routine Gynecological Evaluation.
(11/04/2005)	DME Manual	Durable Medical Equipment Provider Specific Policy Manual Revision Date 11/04/05 Revised Section: 3.6.3 Changed modifier "NU" new equipment to RR Rental (DME).
(10/20/2005)	Pharmacy Manual	Pharmacy Provider Specific Policy Manual Revised 10/20/2005 Sections Revised: Updated section 3.3.1. Added sections 3.3.1.4.1, 3.3.1.6, 3.4.1.1, 3.4.2.1-3.4.2.10, 3.4.3.1 and 3.4.3.2 Added new subsection 3.2.1.1 Updated and added policy to reflect changes in the State Plan that establishes a preferred drug list. Added policy to reflect changes in the State Plan that include a supplemental rebate agreement.
(10/20/2005)	School Providers Manual	School-Based Services Provider Specific Policy Manual Revised 10/20/05 Sections Revised: 5.1 Language is being added to clarify the description of personnel authorized to provide mental health treatment services.
(10/14/2005)	Pharmacy Manual	Pharmacy Provider Specific Policy Manual Revision date 10/14/05 Revised sections: 11.21, 11.7, 11.13, 11.16, 11.17, 11.51, 5.3.2.2.1 Ankylosing Spondylitis has been added as a covered condition. The DMAP preferred product has been added to the top of each form. The prior authorization form for Sildenafil has been added. First Data Bank has been changed to MICROMEDEX.
(10/14/2005)	Practitioner Manual	Practitioner Provider Specific Policy Manual Revision date 10/14/05 Revised sections: 29.20, 29.7, 29.13, 29.16, 29.17, 29.50 Ankylosing Spondylitis has been added as a covered condition. The DMAP preferred product has been added to the top of each form. The prior authorization form for Sildenafil has been added.
(10/06/2005)	Inpatient Manual	Inpatient Hospital Provider Specific Policy Manual Revision Date 10/06/05 Revised Sections: 2.2.1, 2.2.1.1, 2.2.1.2, 2.2.2, 2.2.2.1, 2.2.2.2, 2.2.2.3 and all sections referencing DSS. Updated policy to reflect payment regarding readmission within 10 days to acute care hospital services. Added new heading for certified inpatient physical rehabilitation unit transfer and reformatted section to maintain consistency. Revised throughout to reflect the creation of the Division of Medicaid & Medical Assistance (DMMA).
(10/06/2005)	Hospice Manual	Hospice Provider Specific Policy Manual Revision Date 10/06/05 Revised Sections: 1.1.7 and all sections referencing DSS. Clarification of policy regarding hospice and assisted living was added to section 1.1.7. Revised throughout to reflect the creation of the Division of Medicaid & Medical Assistance (DMMA).
(09/20/2005)	General Policy Manual	General Policy Manual Revision Date 9/21/05 Revised Sections: Sections 1.16.1.10 and all sections referencing DSS. Client pharmacy co-payment added to list of services that may be billed to DMAP clients. Revised throughout to reflect the creation of the Division of Medicaid & Medical Assistance (DMMA).
(09/19/2005)	Pharmacy Manual	Pharmacy Provider Specific Policy Manual Revision date 9/15/05 Added new Section 4.2 Added client co-payment section. Effective date January 10, 2005, DMAP implemented a pharmacy co-payment. Effective July 1, 2005, DMAP implemented a monthly co-payment maximum.
(09/13/2005)	General Policy Manual	General Policy Manual Revision Date 9/12/05 Revised Sections: Sections 2.3, 2.3.1, and 8.0. Revised throughout to reflect the new group managing DSP Behavioral Health Authorizations. Replaced existing Behavioral Health Prior Authorization Request Form with 4 new forms. Reorganized the section and moved all DSP forms to Appendix C, Section 8.0. Changed to reflect the creation of the Division of Medicaid & Medical Assistance (DMMA). Placed all DSP Authorization Forms in previously reserved Appendix C, Section 8.0.
(09/07/2005)	Client Tri-fold	Latest Client Pharmacy Tri-fold.
(08/23/2005)	Assisted Living Manual	Assisted Living Waiver Provider Specific Policy Manual Revision Date 8/23/05 Revised Sections: Section 2.1.7 and All sections referencing DSS Wording has been changed to clarify policy regarding assisted living and hospice. Also, wording has been changed to reflect the creation of the Division Medicaid & Medical Assistance (DMMA).
(08/22/2005)	Practitioner Manual	Practitioner Provider Specific Policy Manual Revision Date 8/22/05 Revised Sections: 29.6, 29.11, 29.12, 29.13, 29.15, 29.20, 29.33, 29.38, 29.46, 29.48, 29.49, All PA Forms Prior authorization criteria was updated to coincide with recommendations by the Drug Utilization Review Board. The DMAP website has been added to the bottom of all prior authorization forms
(08/22/2005)	Pharmacy Manual	Pharmacy Provider Specific Policy Manual Revision Date 8/22/05 Revised Sections: 11.6, 11.11,11.12, 11.13, 11.15, 11.21, 11.34, 11.39, 11.47, 11.49, 11.50, All PA Forms Prior authorization criteria was updated to coincide with recommendations by the Drug Utilization Review Board. The DMAP website has been added to the bottom of all prior authorization forms.
(08/09/2005)	Private Duty Nursing Policy	Private Duty Nursing Policy Manual Update: Revision Date - 8/9/05 replaced sections 1.0-5.1.3 with 1.0-5.3.6 Revised coverage of PDN services. Updated reimbursement rules for serving multiple clients (Effective 3/10/05). Updated prior authorization criteria.
(08/08/2005)	Practitioner Manual	Practitioner Provider Specific Policy Manual Revision Date 8/8/05 Replaced Sections 6.2-6.5.1.9 with sections 6.2-6.3.3.7.2. Revised the definition of sick eye visit. Updated prior authorization criteria.
(07/08/2005)	MCO Transition Information	Attn: All Providers: Revision Date 7/08/05 Moved from Home page September 2005. No change to content.
(06/28/2005)	DMAP Alert	Listserv capabilities added to DMAP website.
(06/06/2005)	Pharmacy Manual	Pharmacy Provider Specific Policy Manual Update: Revision Date - 5/27/05 Sections 11.32, 11.39, 11.47, 11.48.1 Undated prior authorization criteria for Hydromorphone Hydrochloride Extended Release (Palladone®) 2) Added prior authorization criteria for Eszopiclone (Lunesta®) 3) Added prior authorization criteria for Alprazolam Alternative Dosage Forms (Niravam®, Xanax®) 4) Deleted prior authorization form/criteria for Eplerenone (Inspra®).
(06/06/2005)	Practitioner Manual	Practitioner Provider Specific Policy Manual Revision Date 5/27/05 Sections 29.31, 29.38, 29.46, 29.47 1) Updated prior authorization criteria for Hydromorphone Hydrochloride Extended Release (Palladone®) 2) Added prior authorization criteria for Eszopiclone (Lunesta®) 3) Added prior authorization criteria for Alprazolam Alternative Dosage Forms (Niravam®, Xanax®) 4) Deleted prior authorization form/criteria for Eplerenone (Inspra®).
(05/24/2005)	Tri-Fold	Tri-Fold Proof: Information on PDL, Drug Benefit Limits and Co-Pays.
(05/24/2005)	Perm Alert	May 2005 Medicaid Alert
(05/19/2005)	Taxonomy Crosswalk	Attn: All Providers: Revision Date 5/19/05 Moved from Home page September 2005. No change to content.
(05/19/2005)	Directions to DelTech	Directions to the Delaware Technical Community College, Stanton campus.
(05/06/2005)	Pharmacy Billing Manual	Pharmacy Billing Manual Update: Revision Date - 5/05/05 Sections 2.3.1 and 2.3.2 Added two new sections entitled 'NCPDP 5.1 Layouts - Request Reversals' and NCPDP 5.1 Layouts - Request Segments.
(04/25/2005)	MR Waiver Manual	MR Waiver Manual Update: Revision Date - 4/15/05 Sections 2.0, 3.1.1.2, 4.3.1, 5.1.2, 6.2.1, 6.3.2, 6.4.1 - 6.4.2.6, 6.9, 6.10 This revision updates several sections of the manual to 1) add a qualified provider, 2) add eligibility criteria, 3) replace the acronym DMAP with DDDS where applicable, 4) redefine "Clinical Support services". 5) add the definition of "Adult Day Health services", 6) revise the definition of "Residential Habilitation" and 7) add "Transportation" as a waiver service.
(04/11/2005) (04/06/2005)	Practitioner Manual	Practitioner Provider Manual Updates: Revision Date - 3/31/05 Sections - ALL, 29.45, 29.21, 29.43, 29.25 Added Preferred Drug List (PDL) Override Form effective April 1, 2005. The DMAP website address has been added to the header of all pages. Effective April 1, 2005, Lansoprazole no longer requires Prior Authorization for daily or twice daily dosing. Added a chart to the General Requirements section of the PA form for Tegaserod Maleate (Zelnorm®). The prior authorization form for “Disease-Modifying Antirheumatic Drugs (DMARDS)” has been removed. Revision Date- 4/06/05 Sections - 29.12, 29.14, 29.20, 29.27, 29.28 Updated prior authorization criteria for Modafinil (Provigil), Duplicate Therapy, Selective COX-2 Inhibitors (Celecoxib, Valdecoxib), CNS Stimulants and Atomoxetine, and Lidocaine Topical Patch (Lidoderm 5%) Revision Date -4/11/05 Section - 29.23 Changed the Pharmacy Team contact number to read 800-999-3371.
(04/11/2005) (04/06/2005)	Pharmacy Manual	Pharmacy Provider Manual Updates: Revision Date - 3/31/05 Sections - 11.46, ALL, 11.22, 11.44, 11.26 Added Preferred Drug List (PDL) Override Form effective April 1, 2005. The DMAP website address has been added to the header of all pages. Effective April 1, 2005, Lansoprazole no longer requires Prior Authorization for daily or twice daily dosing. Added a chart to the General Requirements section of the PA form for Tegaserod Maleate (Zelnorm®). The prior authorization form for “Disease-Modifying Antirheumatic Drugs (DMARDS)” has been removed. Revision Date - 4/06/05 Sections - 11.12, 11.14, 11.21, 11.28, 11.29 Updated prior authorization criteria for Modafinil (Provigil), Duplicate Therapy, Selective COX-2 Inhibitors (Celecoxib, Valdecoxib), CNS Stimulants and Atomoxetine, and Lidocaine Topical Patch (Lidoderm 5%) Revision Date - 4/11/05 Section 11.24 Changed the Pharmacy Team contact number to read 800-999-3371.
(03/31/2005)	PDL	Updated Preferred Drug List
(03/31/2005)	DUR Notification	DUR Notification: A form of this letter is mailed to all clients when a drug they are taking is placed on the preferred drug list.
(03/31/2005)	PDL Notification	PDL Notification: A form of this letter is mailed to all prescribing practitioners when a drug taken by one of their clients is placed on the preferred drug list.
(03/31/2005)	Overpayment Alert	Overpayment Alert: This alert notifies all providers of DMAP policy regarding the repayment of overpayments.
(03/31/2005)	Client Brochure	Client Pharmacy Brochure: This brochure was mailed to all heads of household. It describes changes to the DMAP pharmacy program and how those changes effect clients.
(03/31/2005)	PDL Alert	PDL Alert: Sent to all physicians, pharmacists, hospitals and long term care facilities on 3/28. It describes changes to the DMAP program related to the preferred drug list (PDL).
(03/31/2005)	DUR Helper	DUR+ Helper: Sent as an attachment to the PDL alert. This mailing is intended to be an aid to prescribing practitioners.
(03/31/2005)	Pharmacy Helper	Pharmacy Helper; Sent as an attachment to the PDL Alert. This mailing is intended to be an aid to dispensing pharmacists.
(03/22/2005)	CMS- 1500 Billing Manual	CMS 1500 Billing Manual Update: Revision Date 3/14/05 Section 2.7 Instructions on billing for office visit co-pays has been added.
(03/22/2005)	UB 92 Billing Manual	UB92 Billing Manual Update: Revision Date 3/14/05 Section 2.6 Instructions for billing emergency room co-pays has been added.
(03/14/2005)	Practitioner Manual	Attn: Practitioner Providers: Revision Date 3/09/05 Section 29.13 The general requirements for the prior authorization form, Phosphorous Binders, are being revised to change the Lanthanum Carbonate dosing from 1500 mg daily to 3000 mg daily.
(03/14/2005)	Pharmacy Manual	Attn: Pharmacy Providers: Revision Date 3/0905 Section 11.13 The general requirements for the prior authorization form, Phosphorous Binders, are being revised to change the Lanthanum Carbonate dosing from 1500 mg daily to 3000 mg daily.
(02/15/2005)	Practitioner Manual	Attn: Practitioner Providers: Revision Date 2/11/05 Section 29.13 The general requirements for the prior authorization form, Phosphorous Binders, are being revised to add the following information to #4:>150pg/mL or PTH>80pg/mL and to correct the spelling of (Pho-Lo) under "Authorization"; it should read (Phos-Lo).
(02/15/2005)	Pharmacy Manual	Attn: Pharmacy Providers: Revision Date 2/11/05 Section 11.13 The general requirements for the prior authorization form, Phosphorous Binders, are being revised to add the following information to #4:>150pg/mL or PTH>80pg/mL and to correct the spelling of (Pho-Lo) under "Authorization"; it should read (Phos-Lo).
(02/11/2005)	Practitioner Manual	Attn: Practitioner Providers: Revision Date 2/04/05 The prior authorization forms for Oral Antifungal and Duloxetine HCI have been removed. A prior authorization form for Step Therapy has been added.
(02/11/2005)	Pharmacy Manual	Attn: Pharmacy Providers: Revision Date 2/04/05 Sections 11.10, 11.35, and 11.45 The prior authorization forms for Oral Antifungal and Duloxetine HCI have been reomoved. A prior authorization form for Step Therapy has been added.
(02/11/2005)	General Manual	Attn: All Providers: Revision Date 2/04/05 Section 1.6.2 Added a section to clarify general provider participation requirements and provider responsibilities for claims submitted to DMAP.
(02/01/2005)	Practitioner Manual	Attn: Practitioner Providers: Revision Date 1/26/05 Section 29.43 The prior authorization form for Tegaserod Maleate (Zelnorm®) has been added. Section 29.42 The prior authorization form a Request for Quantity Limitation Override has been added. Section 29.35 A back page to the prior authorization form titled “Anti-Depressants for the Pediatric Patient”: Anti-Depressant Use in Children and Adolescents has been added. Section 29.41 The new prior authorization form for Anti-Depressants for the Adolescent Patient Between the Ages of 6-18 Years has been added. Section 29.40 The new prior authorization form for Dronabinol has been added.
(02/01/2005)	Pharmacy Manual	Attn: Pharmacy Providers: Revision Date 1/26/05 Section 11.44 The prior authorization form for Tegaserod Maleate (Zelnorm®) has been added. Section 11.43 The prior authorization form a Request for Quantity Limitation Override has been added. Section 11.36 A back page was added to the prior authorization form titled “Anti-Depressants for the Pediatric Patient”: Anti-Depressant Use in Children and Adolescents. Section 11.42 The new prior authorization form for Anti-Depressants for the Adolescent Patient Between the Ages of 6-18 Years has been added. Section 11.41 The new prior authorization form for Dronabinol has been added.
(01/25/2005)	Practitioner Manual	Attn: Practitioner Providers: Revision Date 1/18/05 Three new Prior Authorization forms/criteria are being added: (1) Teriparatide 250 mcg/ml solution; (2) Hydromorphone Hydrochloride Extended Release; and (3) Buprenorphine and Buprenorphine/Naloxone tablets.
(01/24/2005)	Pharmacy Manual	Attn: Pharmacy Providers: Revision Date 1/18/05 Three new Prior Authorization forms/criteria are being added: (1) Teriparatide 250 mcg/ml solution; (2) Hydromorphone Hydrochloride Extended Release; and (3) Buprenorphine and Buprenorphine/Naloxone tablets.
(01/24/2005)	Practitioner Manual	Attn: Practitioner Providers: Revision Date 1/13/05 The prior authorization requirements for Sevelamer are being revised; additionally, the section title is changed to "Phosphorous Binders".
(01/20/2005)	DME Provider Manual	Attn: DME Providers: Revision Date 1/13/05 Several sections in Appendix A are being updated to include 2005 HCPCS supply codes.
(01/20/2005)	Pharmacy Manual	Attn: Pharmacy Providers: Revision Date 1/13/05 The prior authorization requirements for Sevelamer are being revised; additionally, the section title is changed to "Phosphorous Binders".
(01/20/2005)	Practitioner Manual	Attn: Practitioner Providers: Revision Date 1/13/05 Two new Prior AUthorization forms are being added: (1) Anti-Depressants for the Pediatric Patient and (2) Epidermal Growth Factor Inhibitors.
(01/18/2005)	MR Waiver Manual	Attn: MR Waiver Providers: Revision Date 1/12/05 Section 11.35 Code T2015 is being added to Section 8.0 and Code H2012 is being added to Section 8.1. In addition, both Codes (T2015 and H2012) are being added to Section 8.3. These changes are effective 9/1/04.
(01/18/2005)	Pharmacy Manual	Attn: Pharmacy Providers: Revision Date 1/13/05 Two new Prior Authorization forms are being added: (1) Anti-Depressants for the Pediatric Patient and (2) Epidermal Growth Factor Inhibitors.
(01/17/2005)	Co-payment requirement	Information script about the 01/10/05 co-payment requirement.
(12/23/2004)	Brochure Update	Brochure of pharmacy benefit changes effective 1/1/05.
(12/23/2004)	January 2005 Alert	Security changes and log in information for the Interactive Services section of the DMAP website.
(11/29/2004)	General Policy Manual	Attn: All Providers: Revision date 11/22/04 Sections 1.21.4.1, 1.38, 18.0, 19.0 A policy for Related Travel Expense is added. This policy addresses the: reimbursement criteria; limitations and exclusions; and how to obtain prior authorizations for related travel expenses. This policy also gives notice to providers that related travel expenses must be prior authorized regardless where the medical service is provided.
(11/22/2004)	DME Provider Manual	Attn: DME Providers: Revision date 11/18/04 Section 8.9 DMAP is requiring Code A4670 be prior authorized.
(11/04/2004)	Pharmacy Manual	Attn: Pharmacy Providers: Revision date 11/03/04 Section 11.7 This update changes the hematocrit level for chronic renal disease from 33% to 36% in the Restriction section of the Epoetin-Alpha prior authorization requirements.
(11/04/2004)	Practitioner Manual	Attn: Practitioner Providers: Revision date 11/03/04 Section 29.7 This update changes the hematocrit level for chronic renal disease from 33% to 36% in the Restriction section of the Epoetin-Alpha prior authorization requirements.
(10/26/2004)	School Based Services Manual	Attn: School Based Service Providers: Revision date 10/22/04 Section 5.1 Language is being added to clarify the licensing requirements for pathologists/audiologists.
(10/21/2004)	General Policy Manual	Attn: All Providers: Revision date 10/14/04 Sections1.21.4.4, 1.21.5.2, 1.21.5.3, 1.21.5.4 The phrase "Out-of-State Medicaid Coordinator" is changed to "Medical Review Team".
(10/08/2004)	Practitioner Manual	Attn: Practitioner Providers: Revision date 10/05/04 Section 29.18 Synagis for pre-term babies section of the prior authorization requirements is being updated by inserting the word "first" in front of RSV season in three places.
(10/08/2004)	Pharmacy Manual	Attn: Pharmacy Providers: Revision date 10/05/04 Section 11.19 Synagis for pre-term babies section of the prior authorization requirements is being updated by inserting the word "first" in front of RSV season in three places.
(10/07/2004)	Practitioner Manual	Attn: Practitioner Providers: Revision date 10/01/04 Section 29.20 In the General Requirement section of the Selective Cox-2 Inhibitors Prior Authorization Form a change is made in the second co-morbid condition.
(10/07/2004)	Pharmacy Manual	Attn: Pharmacy Providers: Revision date 10/01/04 Section 11.21 In the General Requirement section of the Selective Cox-2 Inhibitors Prior Authorization Form a change is made in the second co-morbid condition.
(10/06/2004)	Practitioner Manual	Attn: Practitioner Providers: Revision date 9/29/04 Section 29.34 Adding the prior authorization requirements for Duloxetine HCI. The requirements are effective immediately.
(10/06/2004)	Pharmacy Manual	Attn: Pharmacy Providers: Revision date 9/29/04 Section 11.35 Adding the prior authorization requirements for Duloxetine HCI. The requirements are effective immediately.
(10/06/2004)	LTC Manual	Attn: Long Term Care Providers: Revision date 9/29/04 Sections 7.1.2.1.1, 7.1.2.1.2, 7.1.2.1.3 and 7.1.2.1.4 LTC facilities use revenue code 0419 to bill the DMAP for oxygen. The oxygen policy is updated to instruct LTC facilities to bill one unit of oxygen per day.
(10/01/2004)	General Policy Manual	Attn: All Providers: Revision date 9/23/04 Sections 1.36.1.2, 1.36.2.2.1 - 1.36.2.2.10, 1.36.5, 1.36.5.1, 1.36.5.2, 1.36.6, 14.0, 15.0 and 16.0 The Medicaid Credit Balance Report (MCBR) is being updated to facilitate recoupment of overpayments more timely.
(10/01/2004)	DME Manual	Attn: DME Providers: Revision date 9/24/04 Sections 7.1 and 12.0 Providers requesting authorization for oxygen must use the Medicare Certificate of Medical Necessity form. This form is added to Appendix E.
(9/14/2004)	School Based Services Manual	Attn: School Based Services Providers: Revision date 8/30/04 Section 9.0 Appendix B is updated to include the universal codes that providers are to use for dates of service on and after 7/1/03.
(9/13/2004)	Long Term Care Manual	Attn: Long Term Care Providers: Revision date 8/30/04 Sections 4.5.1 and 9.1.3 Language is being added regarding the storage of medications for hospitalized residents and making the facility responsible for costs associated with replacing medications that are destroyed or misplaced. Also added is DMAP's requirement for the LTC facility to return any discontinued medications to the dispensing pharmacy that may potentially be dispensed to another client.
(9/13/2004)	Pharmacy Billing Manual	Attn: Pharmacy Providers: Revision date 9/08/04 Sections 2.2, 2.4 and Appendix A Pharmacies must give the DMAP credit for reusable medications returned to the dispensing pharmacy by a long term care facility. Information added on billing a client's primary insurance prior to billing the DMAP. Appendix A added to give the NCPDP Other Coverage Codes.
(9/13/2004)	Pharmacy Manual	Attn: Pharmacy Providers: Revision date 8/30/04 Section 4.1.3 Pharmacies must give the DMAP credit for reusable medications returned to the dispensing pharmacy by a a long term care facility.
(9/09/2004)	Private Duty Nursing Manual	Attn: Private Duty Nursing Providers: Revision date 8/25//04 Sections 6.0 and 7.0 Providers no longer use local codes to bill DMAP for services. Therefore, local codes and references to local codes are being removed from the manual.
(9/09/2004)	MR Waiver Manual	Attn: MR Waiver Providers: Revision date 8/24/04 Sections 7.0, 8.0, 8.1 and 8.3 Providers no longer use local codes. Therefore, references to local codes are removed from the manual. Also, code H2016 (Adult Day Health) is changed to H0043.
(9/09/2004)	EPSDT Manual	Attn: ESPDT Providers: Revision date 8/24/04 Sections All Individual and group EPSDT providers are now able to enroll as DMAP or DSP providers. Therefore, this manual is no longer required.
(9/09/2004)	PPEC Manual	Attn: Prescribed Pediatric Extended Care Providers: Revision date 8/25/04 Sections 3.5.5, 6.0 and 7.0 Providers no longer use local codes. Therefore, references to local codes are removed from the manual.
(9/09/2004)	Practitioner Manual	Attn: Practitioner Providers: Revision date 8/24/04 Sections 18.0 and 19.0 Providers no longer use local codes. Therefore, references to local codes are removed from the manual.
(9/09/2004)	Elderly Disabled Manual	Attn: Elderly and Disabled Providers: Revision date 8/23/04 Sections 7.1.1, 9.0 and 10.0 Providers no longer use local codes. Therefore, references to local codes are removed from the provider manual.
(9/01/2004)	AIDS Waiver Manual	Attn: AIDS Waiver Providers: Revision date 8/23/04 Sections 7.1.1, 8.0 and 9.0 Providers no longer use local codes. Therefore, local codes in Appendix A (section 8.0 - 8.6) are removed from the manual and reference to Appendix A is removed. The local code/description columns are also removed from Appendix B (Section 9.0).
(9/01/2004)	Long Term Care Manual	Attn: Long Term Care Providers: Revision date 8/23/04 Sections 12.0 and 13.0 Providers no longer use local codes. Therefore, local codes in Appendix C are removed from the manual. Reference to 7/1/02 is removed from the title in Appendix D.
(9/01/2004)	Optician Manual	Attn: Optician Providers: Revision date 8/23/04 Sections 6.0 and 7.0. Providers no longer use local codes. Therefore, local codes in Appendix A are are removed from the manual.
(8/27/2004)	Pregnancy Manual	Attn: Extended Pregnancy Providers: Revision date 8/20/04 Sections 2.1.3, 6.0 and 7.0 It is no longer applicable for providers to use local codes. Therefore, Appendix A and reference to Appendix A are removed from the manual.
(8/27/2004)	General Policy Manual	Attn: All Providers: Revision date 8/19/04 Sections 1.16.1.4 and 1.37. CMS interprets a missed appointment as not a distinct reimbursable Medicaid service. Therefore, language is added that will prohibit providers to bill clients for missed appointments (Section 1.37). Further, the language that permits providers to bill clients for missed appointments is being removed from DMAP policy (Section 1.16.1.4).
(8/27/2004)	Dental Manual	Attn: Dental Providers: Revision date 8/19/04 Sections 8.1.2.1, 8.1.2.2, 10.0, 11.0 and 12.0 CMS prohibits providers from billing Medicaid clients for missed scheduled appointments. Section 8.1.2.3 is being removed since DMAP policy cannot allow providers to impose a charge to clients. Local Codes are no longer used by providers when billing DMAP for dental services. Therefore, Appendix A (Section 10.0) is being removed. Also removing reference to 7/1/02 in Sections 11.0 and 12.0 since it is no longer applicable.
(8/27/2004)	Clinic Manual	Attn: Clinic Providers: Revision date 8/20/04 The entire Appendix A (Sections 9.0-9.16) is removed. This Appendix contained local codes used by providers to bill DMAP for dates of service prior to 7/1/02. Local codes are no longer used for billing and therefore not needed. Throughout the manual, references to Appendix A are being removed. In Appendix B (Sections 10.0-10.17) the column where the local code appears is being removed.
(8/27/2004)	Hospice Manual	Attn: Hospice Providers: Revision date 8/20/04 Sections 9.1 and 9.2 Provider do not use local codes to bill for hospice services. Therefore, references to local codes are being removed from the manual.
(8/27/2004)	Home Health Manual	Attn: Home Health Providers: Revision date 8/20/04 Providers no longer use local codes to bill DMAP for services. Therefore, Appendix A and all references are removed from the manual.
(8/26/2004)	Part C to Birth Manual	Attn: Part C Providers: Manual revisions Sections 7.0, Appendix D and Appendix E In Appendix C (Section 7.0) the following changes are made: 1) Local codes, transportation codes and transportation information are no longer needed and are being removed. 2) The Old Code and Modifier columns are being deleted. 3) Revenue code 0551 is deleted and revenue codes 0471 and 0552 are added. Appendix D (Sections 8.0 & 8.1, the Transportation Scheduling Form and Instructions) is being removed. Appendix E-Index F (Section 9.0) is renamed Appendix D (Section 8.0)
(8/17/2004)	Rehabilitation Manual	Attn: Rehabilitation Agency Providers: New Manual - revision date 8/6/04 This is a new provider manual for rehabilitation agencies.
(8/17/2004)	MR Waiver Manual	Attn: MR Waiver Providers: MR Waiver Provider Specific Manual Section 8.1, revision date 9/1/04 Procedure code G9009 has been added. Code G9007 was changed to H2024 or H2024+Mod. U2 (when applicable). The modifier U2 is being removed from code H2024. Code G9011 was changed to code T2024 + Mod. U2 and is now changed to H2024 + Mod. U2.
(8/11/2004)	Dialysis Manual	Attn: Renal Dialysis Facility Providers: New Manual - revision date 7/29/04 This new manual is specific to renal dialysis providers and the services they provide.
(9/01/2004)	MR Waiver Manual	Attn: MR Waiver Providers: MR Waiver Specific Manual Update Sections 8.0 - 8.5 - This revision updates Appendix B. The updates include changing G codes to T codes and adding two new services. The instructions reflect the code changes. Section 8.5 is being added with information regarding the TU modifier.
(7/28/2004)	Practitioner Manual	Attn: Practitioner Providers: Practitioner Provider Specific Manual Update Section 29.27- The prior authorization requirement for CNS Stimulants and Atomoxeline is being updated. In the Authorization section of the request, a Proposed Regiment field is being added. This update is effective immediately.
(7/28/2004)	Pharmacy Manual	Attn: Pharmacy Providers: Pharmacy Provider Specific Manual Update Section 11.28 - The prior authorization requirement for CNS Stimulants and Atomoxeline is being updated. In the Authorization section of the request, a Proposed Regiment field is being added. This update is effective immediately.
(7/29/2004)	General Policy Manual	Attn: All Providers: General Policy Manual Update Section 1.17- Clarifying policy regarding "physicians billing Medicaid clients for copying client records and completing prior authorization forms.
(7/29/2004)	Hospice Manual	Attn: Hospice Providers: Hospice Provider Specific Manual Update Section 5.0 - Adding a Reimbursement Methodology section which includes an example of how the reimbursement amount is calculated.
(7/28/2004)	DME Manual	Attn: DME Providers: DME Provider Specific Manual Update Section 8.1 - Adding codes A4221 and A4222
(7/12/2004)	DMAP application	Attn: DMAP Providers: Individual Application Update Added taxonomy for Licensed Professional Counselor Mental Health (LPCMH) and CMS Disclosure requirement.
(7/12/2004)	Xover Form	Attn: DMAP Providers: Crossover Enrollment Form Update Added CMS Disclosure requirement.
(7/12/2004)	Provider Alert	Attn: DMAP Providers: Provider Alert Claim adjustments to be processed on 7/19/04 for claims paid for Specified Low Income Medicare Beneficiaries between July 1, 2002 and March 4, 2004.
(7/02/2004)	Aids Manual	Attn: Aids Waiver Providers: Manual Revision Date 6/28/04 Section 5.2.1.7 Corrected the address and phone numbers for the Long Term Care Administrator.
(7/02/2004)	Elderly and Disabled Manual	Attn: Elderly and Disabled Waiver Providers: Manual Revision Date 6/28/04 Section 11.2 Corrected the phone and fax numbers for the DSAAPD Administration.
(7/02/2004)	Assisted Living Manual	Attn: Assisted Living Providers: Manual Revision Date 6/28/04 Section 11.2 Corrected the phone and fax numbers for DSAAPD - Administration.
(7/02/2004)	Hospice Manual	Attn: Hospice Providers: Manual Revision Date 6/28/04 Section 6.1.3 Corrected the phone number for Kent and Sussex Counties Pre-Admission Screening Unit.
(7/02/2004)	MR Waiver Manual	Attn: MR Waiver Providers: Manual Revision Date 6/28/04 Section 5.1.4 Corrected the address and phone number for the Division of Developmental Disabilities Services.
(7/02/2004)	General Policy Manual	Attn: All Providers: Manual Revision Date 6/28/04 Sections 9.0, 18.2,18.3 and 18.4 Correcting addresses and phone/fax numbers in several sections of the policy.
(7/02/2004)	Long-Term Care Manual	Attn: Long-Term Care Providers: Manual Revision Date 6/28/04 Section 4.6.3 Correcting address and phone numbers for the LTC Administrator.
(7/02/2004)	Home Health Manual	Attn: Home Health Providers: Manual Revision Date 6/28/04 Sections 7.2.1 Corrected phone number for the Medical Review Team in the Robscott Building.
(6/28/2004)	Pharmacy Manual	Attn: Pharmacy Providers: Manual update Sections 11.15 - 11.26 and 11.32 Adding language to the prior authorization requirements for Cholinesterase Inhibitor, DMARDS and Eplerenone.
(6/28/2004)	Practitioner Manual	Attn: All Providers: Manual update Sections 29.15, 29.25 and 25.61. Adding language to the prior authorization requirements for Cholinesterase Inhibitor, DMARDS and Eplerenone.
(6/28/2004)	DME Manual	Attn: DME Providers: Manual update Section 9.0 For clarification the TOS column is being changed to MOD. Also, TOS-Type of Service is changed to MOD-Modifier.
(6/28/2004)	General Policy Manual	Attn: All Providers: Manual update Sections 1.31 - 1.35 A section is being inserted that will address the Delaware Cancer Treatment Program. This is a state funded program to provide coverage for cancer patients. The program will be effective 7/1/04. The current manual sections 1.31 - 1.35 have been renumbered to 1.32 - 1.36.
(6/23/2004)	Pharmacy Manual	Attn: Pharmacy Providers: Manual update Sections 11.32 - 11.34 Prior authorization requirements have been added for Eplerenone, Tiotropium Bromide Inhalation Powder and Cinacalcet. Several of the authorization forms have had the requirement for a physician signature removed and the requirement for a provider number added. Language has been added to 11.16, 11.17, 11.21 and 11.28.
(6/23/2004)	Practitioner Manual	Attn: Practitioner Providers: Manual update Prior Authorization requirements are being added for Eplerenone, Tiotropium bromide inhalation powder and Cinacalcet. Changed "Physician Name" to "Practitioner Name" and added Provider Number to several prior authorization requirements. Removed the requirement of the Physician Signature from several requirements. Added language to the following prior authorization requirements: 29.16, 29.17, 29.20, 29.26 and 29.27.
(6/11/2004)	Hospital Provider Manual	Attn: Inpatient Hospital Providers: Manual update A section is being inserted to clarify policy regarding prior authorization for admission into an out-of-state rehabilitation hospital. The inserted section causes sections 5.2 - 5.4 to be renumbered 5.3 - 5.5. On prior approval requests the Fax number was corrected and the Attention line in the address was removed.
(6/11/2004)	DMAP Alert	DMAP Provider June 2004 Medicaid Alert
(6/10/2004)	DMAC list	Attn: Pharmacy Providers: DMAC list update
(5/27/2004)	Practitioner Manual	Attn: Practitioner Providers: Manual update Revision Date 5/25/04 Sections 29.13 and 29.30. The prior authorization requirements for Sevelamer have been revised and prior authorization requirements are being added for Hemophilia Factor.
(5/27/2004)	Pharmacy Manual	Attn: Pharmacy Providers: Manual Update Revision Date 5/25/04 Sections 11.13 and 11.31. The prior authorization requirements for Sevelamer have been revised and prior authorization requirements have been added for Hemophilia Factor.
(5/18/2004)	CDC Alert	Attn: All Providers: CDC Alert 5/04 The Centers for Disease Control and Prevention (CDC) is advising that providers should stop giving the third and fourth doses of the pneumococcal vaccine to children due to a supply shortage.
(5/05/2004)	DME Provider Manual	Attn: DME Providers: DME Provider Manual Revision Date 5/03/04 Section 8.14 Codes A7520 - A7526 will require prior authorization instead of allowing a 3-month limit of 15 units.
(5/04/2004)	Community Support Services Provider Manual	Attn: Community Support Services Providers: New Provider Specific Manual This new manual replaces the Community Support Services Mental Health and the Community Support Services Substance Abuse Provider Specific manuals. This manual more accurately describes the community support services covered under the Rehab Option.
(5/04/2004)	General Policy Manual	Attn: All Providers: General Policy Manual Revision date 4/29/04 Sections 2.3.5.5, 2.3.5.8, 2.3.6, 2.3.6.1, and 18.5- The revisions are being made to ensure compliance with CMS regulations/requirements for MCOs. Section 18.5 is being added to give the address for DSAMH.
(4/30/2004)	Independent Therapist Provider Manual	Attn: Independent Therapy Providers: New Provider Specific Manual Prior to 5/1/04, DMAP did not enroll or reimburse independent therapists for services.
(4/23/2004)	Dental Billing	Attn: Dental Billing Providers: Dental Providers Manual Update Section 2.3 Revision date 4/23/04 - The statement in field 59 under Quantity "If blank, a quantity of 1 will be auto plugged" has been removed.
(4/22/2004)	Extended Pregnancy Providers	Attn: Extended Pregnancy Providers: Provider Manual Update Section 1.1.3 Revision date 4/20/04 - Providers of extended pregnancy services must ensure that all professional staff are properly licensed and the licenses are current. This clarification is being added to the Provider Responsibility section of the manual.
(4/16/2004)	General Policy Manual	Attn: All Providers: General Policy Manual Update Sections 1.2.1.2, 1.2.1.2.1 and 8.0 - Revision date 4/15/04 - Language is being revised with instructions to providers how they may receive a paper copy of manual updates. The reference to the Update Control Log has been deleted.
(4/15/2004)	Extended Pregnancy Providers	Attn: Extended Pregnancy Providers: Provider Manual Update Section 7.0 Revision date 4/13/04 - The modifier TH is being removed from Appendix B. Providers are not required to use this modifier when billing code T1002.
(4/13/2004)	DSP Providers	Diamond State Partners: DSP Provider List as of 2/04.
(4/13/2004)	DSP Other Providers	Diamond State Partners: List of Durable Medical Equipment, Laboratory and Radiology Providers as of 2/04.
(4/05/2004)	Clinic Provider Manual	Attention: Clinic Providers Provider Manual Update Section: 10.16 - Revision date 4/1/04 - Local codes are being removed from the chart. The billable codes for Mental Health Clinics are expanded to include 90804-90809 and guidelines for billing have been added.
(3/22/2004)	Practitioner Provider Manual	Attention: All Providers Practitioner Provider Manual Update Sections: 1.0, 15.0 and 28.30- The DMAP is adding Clinical Nurse Specialist to the list of provider types that utilize this manual. A specific criteria for psychiatrist section is being added to clarify the codes this provider type must use when billing DMAP. Prior authorization requirements are being added for Levalbuterol HCI effective 4/1/04.
(3/15/2004)	Pharmacy Provider Manual	Attention: Pharmacy Providers Provider Manual Update Effective 4/1/04, Section 11.30, Prior authorization requirements are being added for Levalbuterol HCI (Xopenex).
(3/15/2004)	General Billing	Attention: All Providers Update to General Billing Manual Section 2.5 effective 1/23/04 - A clarification of the timely filing guidelines for adjustments.
(3/15/2004)	Pharmacy Billing	Attention: Pharmacy Providers Provider Manual Update Section 1.0 and 2.2, Changing POS-DUR timely filing limit from 14 days to 100 days.
(3/15/2004)	General Policy	Attention: All Providers General Policy Manual Update, Section 1.19.1.2 Changing the POS-DUR program filing limit from 14 days to 100 days.
(3/08//2004)	March Bulletin	Download and view the March special Medicaid provider bulletin, Vol 18.
(2/24/2004)	Pharmacy Provider Manual	The POS/DUR timely filing limit is revised from 14 days to 100 days. This change will ease the administrative burden on the provider community and will reduce the time for clients to be reimbursed when their eligibility has been retroactively determined.
(2/06/2004)	General Policy Manual	Section 1.19.3 Clarifying "timely filing" policy.
(2/06/2004)	Practitioner Provider Manual Pharmacy Provider Manual	Adding prior authorization requirements for CNS Stimulants/ atomoxetine and Lidocaine Topical Patch effective 2/23/04.
(1/28/2004)	Pharmacy Provider Manual	Coverage of OTC products/supplies for residents in a LTC facility is being clarified in Section 2.1.4. This policy is effective 1/1/04. Also clarifying the DMAC/FUL (effective 1/1/04) and Reimbursement policies (effective 1/10/03). Effective 1/13/04, the prior authorization requirements for 5-HT3 Receptor Antagonists, Sevelamer and Cholinesterase Inhibitors are revised. Also, the same effective date, prior authorization requirements for DMARDS and Risperdal Consta are being added.
(1/28/2004)	Long Term Care Manual	A Reimbursement section is being added. The information regarding the reimbursement methodology is not a new policy. It is clarification of current policy. The current Section 9.0 - 12.0 will be changed to 10.0 - 13.0.
(1/15/2004)	UB92 Billing Manual	Language is being added to clarify UB-92 billing instructions for form locator 42 to reflect appropriate LOA revenue codes for nursing homes and assisted living facilities. Both state and non-state LTC facilities will use leave of absence codes 0183, 0185, and 0189. Assisted living facilities will use only 0189. In addition, form locators 42 and 46 have been updated to reflect the 4-digit revenue codes.
(1/14/2004)	DME Manual	DME Provider Specific Manual: Several sections in Appendix A are being updated to include 2004 HCPCS codes.
(1/14/2004)	Hospice Manual	Effective 12/10/03 "bed-hold" days are being reduced from 14 to 7 days per hospitalization in any 30-day period. This change is consistent with those made in the Long Term Care Provider Specific Policy Manual.
(1/13/2004)	Pharmacy Alert	January 2004 Pharmacy Alert.
(12/19/2003)	Practitioner Manual Pharmacy Manual	Pharmacy Provider Specific and Practitioner Provider Specific Manuals: The Proton Pump Inhibitors prior authorization criterion is being revised and a new prior authorization criterion is being added for Nicotine Replacement Therapies. Language is being added to the manual that requires prior authorization for brand medications if a generic product is available.
(12/09/2003)	AIDS Waiver	AIDS Waiver Provider Specific Manual: Local Codes were mapped to 90804. However, providers could not bill for more than 1 unit (up to 30 minutes). Codes 90806 and 90808 are being added to give providers the capability to bill for services up to 50 and 80 minutes. These codes can be used for dates of service on and after 3/1/03.
(12/09/2003)	General Policy Manual	General Policy Manual: Services provided by a dentist are being added to the list of services provided in Delaware, NJ, MD, PA and the District of Columbia that do not require prior authorization.
(12/09/2003)	Long-Term Care Provider Manual	Long Term Care Provider Specific Manual: Effective 12/10/03 "bed-hold" days are being reduced from 14 to 7 days per hospitalization in any 30-day period. Also, as not to complicate the issue, the examples in Section 4.5.2 are being removed.
(12/09/2003)	Part C Provider Manual	Part C Birth to Three Provider Specific Manual: Local codes T110H and TV10H were mapped to the proposed code S4386. CMS did not approve the use of this code, and in order to be in compliance with HIPAA, DMAP is changing the code to the existing HCPCS code T1023. This change is effective for dates of service on and after 1.1.04. Providers will find this change is Section 7.1 of their provider manual.
(11/24/2003)	Clinic Provider Manual	Clinic Provider Specific Manual: During the process of crosswalking local codes to existing HCPCS codes DMAP assigned two proposed codes for DPH clinic to use when billing for services. However, CMS did not approve the codes assigned (S4516-Multli-disciplinary assessment/evaluation and S4518-Environmental lead testing). Therefore, it is necessary for DMAP to crosswalk previously assigned code to existing HCPCS codes. The newly assigned codes are to be used when billing for dates of service on and after 1/1/04.
(11/24/2003)	DME Provider Manual	DME Provider Specific Manual: Changing the Titles in Appendix A to match those as listed in the HCPCS book. Also, modifying the 3-month limit for code A4927 to be consistent with the definition in the 2003 HCPCS book. Effective 1/1/03.
(11/24/2003)	Practitioner Provider Manual	Practitioner Provider Specific Manual: Effective 10/1/02, DMAP limited home health aid services to 2 hours per day with additional hours requiring prior authorization. This policy applies to all ages. Although the change was made in the Home Health Provider Manual it was not reflected in the Practitioner Manual. Effective 10/1/02.
(11/24/2003)	Substance Abuse Manual	Community Support Substance Abuse Provider Manual: A billing information section is being added to give providers guidelines for billing the series of codes 90804 - 90809. Effective 10/1/03.
(11/24/2003)	Mental Health Manual	Community Support Mental Health Provider Manual: A billing information section is being added to give providers guidelines for billing the series of codes 90804 - 90809. Effective 10/1/03.
(11/20/2003)	November Bulletin	Download and view the November 2003 special Medicaid Provider bulletin, Vol. 17.
(11/12/2003)	PPEC Provider Manual	PPEC Provider Specific Manual: Complete manual revision effective 11/10/03.
(11/11/2003)	Home Health Provider Manual	Home Health Provider Specific Manual: Home Health agencies must use a HCPCS procedure code along with a Revenue Center Codes when billing the DMAP for services. Revenue Center Codes are being added to the HCPCS procedure code table in Appendix B. This addition will assist providers when billing the DMAP.
(11/05/2003)	Hospice Provider Manual	Hospice Provider Specific Manual: Corrected Revenue Center Codes form a 3-digit number to a 4-digit number.
(11/05/2003)	Long Term Care Provider Manual	Long Term Care Provider Specific Manual: Corrected revenue center codes used by nursing facilities when billing for respiratory and therapy services. Updated the revenue codes from a 3-digit number to a 4-digit number. The order in which they appear in the table is changed so the codes are in numeric order.
(11/05/2003)	Part C Birth to Three Provider Manual	Part C Birth to Three Provider Specific Manual: Revenue center codes changed from a 3-digit to a 4-digit number. Updated the definition of revenue codes in Section 3.0 as well as updating the revenue code chart in Appendix C.
(10/23/2003)	Home Health Provider Manual	Home Health Provider Specific Manual: 1) Clarifying definition of skilled nursing visit. The clarification clearly indicates that behavioral health services are not covered by DMAP as a home health benefit. This clarification of policy is reflected in Sections 3.2.1 and 6.1.4 and is effective immediately. 2) In compliance with the Newborns' and Mothers' Health Protection Act of 1996, the early postpartum discharge in-home assessment policy is being updated to include change in hospital stay for vaginal/cesarean delivery. "First-time mom/baby" postpartum visit is being added to Section 6.1.9 which entitles this population to the same services. 3) Portions of Section 6.1 are being renumbered so text can be put in a more appropriate order. Many of the numbers are being removed and replaced a bullet or other identifying symbol. Also, in this section, all mention to specific sections of the manual are being replaced by the Name of the section This update is effective immediately.
(10/16/2003)	Practitioner Provider Manual	Practitioner Provider Specific Manual: This update is to provide referring practitioners with information needed when requesting prior authorization for PET Scans. This update is effective immediately.
(10/16/2003)	General Policy Manual	General Policy Manual: 1) Adding prior authorization requirements for PET Scans. This is effective immediately. 2) Adding home health services that require prior authorization. These services are currently listed in the Home Health Manual but were not included as part of the General Policy. This was effective 7/1/02. 3) Prior authorization for oral and facial prosthetics was added to the Practitioner Manual but not included in the General Policy. This was effective 1/1/02.
(10/16/2003)	Outpatient Provider Manual	Outpatient Hospital Provider Specific Manual: This update provides outpatient hospitals with information regarding the billing of PET Scans. The update is effective immediately.
(10/10/2003)	Pharmacy Provider Manual	Pharmacy Provider Specific Manual: Updating prior authorization criteria for Oxycodone and Morphine Sustained Release Product, Fentanyl Transdermal, Medication Claims Over $500 and Synagis (Sections 11.16-11.19). The updates are effective immediately.
(10/10/2003)	Long Term Care Provider Manual	Long Term Care Provider Specific Manual: Language is being added to Section 7.0 that will clarify how ancillary services for nursing facility residents are to be billed. This is not a new policy. It is clarification of current policy.
(10/10/2003)	Practitioner Provider Manual	Practitioner Provider Specific Manual: Updating prior authorization criteria for Oxycodone and Morphine Sustained Release Product, Fentanyl Transdermal and Synagis (Sections 28.16-28.18). The updates are effective immediately.
(10/10/2003)	Clinic Provider Manual	Clinic Provider Specific Manual: School-based Wellness Center services were provided in an educational setting, but coverage was not added to the Clinic Provider Manual. Family and Children Services section is being deleted because it is not applicable to this manual.
(10/08/2003)	DME Provider Manual	DME Provider Specific Manual: Code A7042 is in the MMIS with a PAC 9 (non-covered service) and was erroneously added to Section 8.14. It is being removed effective immediately.
(10/08/2003)	Part C Birth to Three Provider Manual	Part C Birth to Three Provider Manual: Effective 9/1/03 DMAP contracted with a broker to provide transportation services to eligible Part C clients. The manual is updated to reflect this change. Information found in Sections 1.2 (Updates) and 6.0 (Update Log) is found in the General Policy and therefore is being deleted.
(10/07/2003)	Practitioner Provider Manual	Practitioner Provider Manual: This update is to clarify policy regarding how providers are to bill for injections. This clarification is effective immediately.
(09/04/2003)	Pharmacy Alert	Download and view the August 2003 Pharmacy Alert.
(08/22/2003)	Pharmacy Provider Manual Practitioner Specific Manual	Pharmacy Provider and Practitioner Specific Manuals: adding the early refill form for prior authorization.
(08/22/2003)	August Special Bulletin	Download and view the August 2003 special Medicaid Provider bulletin.
(08/18/2003)	DMAP and DSP Enrollment	DMAP and DSP Enrollments - A CMS 1513 will be required for new groups enrolling with DMAP and DSP. Effective 8/7/03
(08/18/2003)	Disclosure Statement	CMS 1513 Disclosure Statement - This form will be required for all new provider enrollments except the Department of Public Health and State facilities. Effective 6/1/03
(08/01/2003)	Substance Abuse	Community Support Services; Substance Abuse Provider manual - Added 3.115 and 10.0; revised 5.1.1, 5.1.2, 5.1.3, 5.1.5, 6.1.1- This update complies with recent State Plan revisions that change the rate-setting methodology for the rehabilitative services option and adds language to revise and clarify coverage policies. Effective 8/10/03
(08/01/2003)	Mental Health	Community Support Services; Mental Health Provider manual - Added 3.1.1.5 and 13.0; revised 5.1.1.1, 5.1.1.3, 5.1.1.5, 5.1.1.6, 5.1.1.7, 6.1.1.1- This update complies with recent State Plan revisions that changed the rate-setting methodology for the rehabilitative services option and adds language to revise and clarify coverage policies. Effective 8/10/03.
(08/01/2003)	General Policy	General Policy manual - Added a new Section 1.17 - Although the DMAP does not reimburse providers for copying or transferring client records, examples are being added to assist providers in determining when and when not to charge the client for the service. This update is being added as Section 1.17. All sections following are renumbered in the Table of Contents and in the body of the manual. Effective 8/1/03.
(07/21/2003)	Pharmacy Billing	Pharmacy Billing manual - Section 2.4 - Adding clarification under Prescriber ID, Section 2.6 has been added to include the DMAC Pricing Inquiry Worksheet effective 8/1/03.
(07/02/2003)	Practitioner Provider	Practitioner Provider Specific manual - Section 28.22 - Adding prior authorization criteria for Enfuvirtide effective 7/1/03.
(06/10/2003)	Pharmacy Provider	Pharmacy Provide Specific manual - Section 11.23 - Adding prior authorization criteria for Enfuvirtide effective 7/1/03.
(06/10/2003)	DME Provider	DME Provider Specific manual - Currently, the DMAP uses a miscellaneours code for a trach tube holder. Effective for dates of service 7/15/03 providers shall use the temporary HCPCS code S8181.
(06/10/2003)	General Policy	General Policy manual - Section 1.18.2 - Language has been added to clarify the Claims Submission-Timeliness policy.
(06/02/2003)	Practitioner Provider	Practitioner Provider Specific manual - Section 14.0 - Added a new Section 14.0 to define the service coverage for Prosthodontists effective 1/1/02.
(06/02/2003)	General Policy	General Policy manual - Section 2.3.5.8 - Added billing instructions for DSP providers billing for Behavioral Health Services effective 7/1/02.
(05/27/2003)	PPEC Provider	PPEC Provider Specific manual - Section 7.0 - The definitions for the revenue center codes were corrected effective 7/1/02.
(05/27/2003)	June Special Bulletin and Insert	Download and view the June 2003 special Medicaid Provider bulletin and insert.
(05/19/2003)	DUR Board Notes	The new DUR Board Notes are now available on Pharmacy Corner.
(04/29/2003)	Awareness Form	The Awareness Form is now available for download under the General Forms section of the downloads page.
(04/21/2003)	Pharmacy Alert	This Alert is intended for all practitioners who write prescriptions and all pharmacy providers who dispense medications to DMAP clients. Prior authorization forms for two common drug classes are included with the Alert for use effective 5-01-03. An Atypical Dosing Chart is also presented as reference material.
(04/21/2003)	Practitioner Provider	Effective 5/1/03, Medicaid may limit the quantity and duration of medications based on clinical appropriateness. Adding Prior authorization requirements for Selective Cox-2 Inhibitors and Proton Pump Inhibitors.
(04/17/2003)	Pharmacy Billing	Removed the work "not" from the first sentence of the third bullet under Section 2.2.
(04/17/2003)	Part C to Three Provider	The "TL" modifier is being removed effective for dates of service on or after 5/1/03. The modifier is not necessary in determining a program, funding source information, pricing or reporting for Part C so therefore, is not needed when billing services.
(04/11/2003)	Pharmacy Provider	Effective 5/1/03, Medicaid limits on the quantity and duration of medications based on clinical appropriateness is being added as sections 3.4.2 and 3.4.3. Prior authorization requirements for Selective Cox-2 Inhibitors and Proton Pump Inhibitors is being added as sections 11.21 and 11.22.
(04/04/2003)	Hospital Provider	Effective 1/1/03, reimbursement policy regarding interim payment to inpatient hospitals is being added as Sections 2.8.2.1 through 2.8.2.4. This update to the reimbursement methodology gives the provider access to funds sooner than normal.
(03/28/2003)	General Policy	Effective immediately, changes in Section 1 are in compliance with the 2003 Federal Poverty Level guideline. Effective 1/1/03, changes in Section 2 lift the 31-day cap on reimbursable mental health and substance abuse treatment for those eligible to receive benefits through the Delaware Healthy Children Program (DHCP).
(03/18/2003)	Web Info	Download and view the March 2003 DMAP Web Review guide insert.
(03/18/2003)	March Special Bulletin	Download and view the March 2003 special Medicaid Provider bulletin.
(03/17/2003)	Pharmacy Billing Manual	Correction made to page 4, third bullet: "Claims for prescriptions that are not dispensed and are returned to the pharmacy stock should be credited by reversing the claims."
(03/13/2003)	Provider Crossover Alert	Download and view the March 2003 Provider crossover alert.
(02/13/2003)	Practitioner Provider Manual	Effective 1/17/03: Sections 26.12, 26.17, added 26.19* Clarifying prior authorization criteria for requesting specific drugs. Added 13.0, renumbered 14.0 through 28.0 A specific criteria section (13.0) is being added for FQHC providers. This addition will require the current sections 13.0 - 27.0 to be renumbered 14.0 - 28.0.
(02/13/2003)	MR Waiver Provider Manual	Effective 3/01/03: Section 8.0 - Changed code H2034 to H2024 and removed "9" from all definitions of S5145.
(02/07/2003)	General Policy Manual	Added 2.3.5.8, which is a description of Diamond State Partners behavioral health benefit.
(02/04/2003)	DME Provider Manual	Effective 1/1/03: Added new supply codes, revised definitions of current codes and deleted supply codes as per 2003 HCPCS book. Effective 1/17/03: Clarification of policy. When using the Medicare Certificate of Medical Necessity (CMN) providers must supply Medicaid with the requested dates of service and number of units being requested. This information must be indicated in Section C of the CMN. Prior authorization cannot be given without this information.
(02/04/2003)	Pharmacy Provider Manual	Effective 1/17/03: Clarifying prior authorization criteria policy.
(01/16/2003)	MR Waiver Manual	Effective 3/1/03: Section 8.0, Appendix B, is being updated to include CMS approved HCPCS codes that better describe original service. The update reflects the progression of codes, description and date of service each code is to use.
(01/16/2003)	General Policy Manual	Effective 7/1/02: Corrected typographical error. The reference to 7(a) should read 6(a).
(01/16/2003)	Elderly and Disabled Waiver Provider Manual	Effective 3/1/03: Section 10.0, Appendix C, is being updated to include CMS approved HCPCS codes that better describe original service. The update reflects the progression of codes, description and date of service each code is to use.
(01/16/2003)	AIDS Waiver Provider Manual	Effective 3/1/03: Section 9.0, Appendix B, is being updated to include CMS approved HCPCS codes that better describe original service. The update reflects the progression of codes, description and date of service each code is to use.
(01/16/2003)	Home Health Provider Manual	Effective 1/18/03: A chart is added in Section 4.2 to assist providers in determining the number of units to bill when using 15-minute increments. Skilled rehab limits are being added.
(01/14/2003)	Software Page	Provider Electronic Solutions Software Version 2.02 now available on the software page.
(01/06/2003)	December 2002 Special Bulletin	View the DMAP Provider Alert on the bulletins page.
(01/06/2003)	Dental Benefit Guide	Dental Benefit Guide- a guide to determine dental coverage based on DMAP programs.
(12/10/2002)	General Policy Manual	General Policy Manual Updates: Effective 1/1/03, the name Champus (military insurance) will be changed. Also, routine eye exams and eyeglasses for adults over the age of 21 will no longer be included in the MCO benefit package.
(12/04/2002)	Non-emergency Provider Specific Manual	As of 10/1/02, DMAP utilized a broker system to provide ALL non-emergency transportation (including non-emergency ambulance) to eligible Medicaid clients. The entire manual has been archived.
(12/04/2002)	DMAP Ambulance Provider Specific Manual	DMAP utilized a broker system to provide ALL non-emergency medical transportation (including non-emergency ambulance transportation) to eligible Medicaid clients. Sections of the Ambulance Provider Specific Policy Manual, specifically those sections regarding non-emergency transportation services, are updated to reflect the new broker system.
(12/04/2002)	LTC Provider Specific Manual	Changing nursing home to nursing facility to make language consistent throughout the section.
(12/04/2002)	dme provider specific Manual	Changing nursing home to nursing facility making language consistent throughout this section.
(12/04/2002)	General Prolicy Manual	Multiple Sections Revised: Section 1.7.2.9 - Effective immediately - As per licensing requirements. Section 1.20.6.1.3 - Effective 11/15/02 - As per DME policy. Sections 1.28.1.1 - 1.28.2.1.3 - Effective 10/1/02 - As per Transportation Policy Section 1.34.2.2.8 - Effective 1/1/03 - To comply with SUR Unit procedures
(12/03/2002)	EFT Form	Electronic Funds Transfer Form has been added to the forms page.
(12/03/2002)	Paper Survey	Paper vs No Paper Survey: A survey regarding the need for paper mailings.
(12/03/2002)	November Special Bulletin	View the DMAP Provider Alert on the bulletins page.