Delaware Provider Enrollment – Frequently Asked Questions
In compliance with 42 CFR § 438.602 and 42 CFR Part 455, subparts B and E and the 21st Century Cures Act (PDF), Delaware Medicaid is required to screen and enroll all current and prospective Managed Care Organization-Only Providers (MCOPs).
In June 2022, the Delaware Medical Assistance Program (DMAP) sent registration letters to current In-Network MCOPs to initiate the screening and enrollment process. MCOPs with multiple National Provider Identifiers (NPIs) and taxonomies received separate letters. The letters indicated the unique ID and address for each service location associated with the NPI and taxonomy combination. In some cases, duplicate unique IDs were assigned due to slight differences in reported addresses (ex. Suite vs STE). MCOPs must verify and enroll the correct ID and address with DMAP to continue to receive Medicaid payments for services. Failure to successfully enroll with DMAP will result in termination of the Medicaid contract associated with each un-enrolled service location.
The new deadline for all current MCOPs to complete the enrollment application is September 30, 2023. Please ensure that current contact information is up-to-date and be sure to register each service location. DMAP would like to reiterate that providers that are currently engaged are not at risk of losing a suspended payment and/or termination from the Delaware Medicaid Program and Managed Care Organization (MCO) network participation.
We encourage you not to wait and to enroll all service locations as soon as possible. EACH location will receive a unique Medicaid ID for your individual utilization, for rendering services.
Did you know?
The Centers for Medicare and Medicaid Services (CMS) requires States to deny claims from providers who are not enrolled in the States Medicaid or CHIP programs. These claims include reimbursement for services rendered, prescriptions, referrals, and orders for lab work and tests. Enroll in the Delaware Medical Assistance Program (DMAP) today!
Ordering, Referring, & Prescribing (ORP) Providers
Ordering and Referring Providers are physicians or other professionals that only order or refer items or services for Medicaid beneficiaries. These providers do not submit claims for reimbursement for any services provided but are required to enroll solely for the purposes of ordering and referring services for Medicaid beneficiaries. Ordering and referring providers are required to complete a limited-capacity enrollment form so that DMAP may identify the providers who write only orders, referrals, and prescriptions. Enrollment is required so that payments can be made for claims related to client services. This requirement does not apply to providers who are enrolled with the Delaware managed care organizations.
Managed Care Only Providers (MCOPs)
In compliance with 42 CFR 438.602 and 42 CFR Part 455, subparts B and E and the 21st Century Cures Act states must screen, enroll, and revalidate MCO network providers according to Program Integrity enhanced screening provisions. MCOPs are required to complete a streamlined provider enrollment application to conduct federally mandated screening activities. This provider enrollment application is mandatory for all MCO providers at initial enrollment, reenrollment, revalidation and for continual participation (registration) with the Managed Care Organization (MCO) under Delaware’s Medicaid Program. In accordance with federal guidelines, the MCOP application process will standardize screening processes for DMAP/fee for service (FFS) providers and MCOPs alike, overall enhancing member services. MCOPs are not required to provide services to DMAP/ FFS members, however the DMAP / FFS enrollment application is available on the Delaware Medical Assistance Portal for providers that chose to participate in both the DMAP/FFS Program and Delaware Managed Care Organization Networks.
How do I enroll?
Apply online at the following link: Provider Enrollment (delaware.gov)
What do I need to enroll?
List of all forms and documents listed here: Enrollment Welcome (delaware.gov)
How do I Track my Provider Enrollment Applications?
After you have entered your basic demographic information, the web-based system will document your application and notify you for next steps.
Who should I contact with further questions?
If you have questions about Delaware Health and Social Services (DHSS) enrollment or need help, call 8:00 a.m. - 4:30 p.m. 1-800-999-3371.
For questions concerning why Envolve has requested you act, please contact Customer Service at 833-236-1886.
For More Information:
- Read the Rule: https://www.govinfo.gov/content/pkg/FR-2016-05-06/pdf/2016-09581.pdf (PDF)
- Check out the Announcement Section on the DMAP Provider Portal for MCO Provider Screening and Enrollment updates.