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21ST CENTURY CURES ACT REMINDERS

Date: 10/21/24

Delaware First Health is committed to supporting our network providers with compliance with the 21st Century Cures Act (CCA) mandatory provider enrollment requirements. Below is some helpful information to assist you through the process.

Who Needs to Register with Delaware Medical Assistance Program (DMAP)

  • Billing providers (group or entity being reimbursed for services rendered to the member) must register each NPI/taxonomy/service location(s) where services are rendered.
  • Non-Billing providers (rendering/attending/performing or referring/ordering/prescribing) listed on a claim only need to register at their main practice location.
  • How to Register and Reset Your Existing Application with DMAP Visit DMAP Portal website at https://medicaid.dhss.delaware.gov/provider and select the “Provider Enrollment” link and the “MCO Only Provider Enrollment Application”
  • To avoid gaps in your enrollment effective date, reset an existing application (instead of submitting a new application) Click here for reset instructions.

Confirming Registration Status with DMAP

  • Contact DMAP Provider Services by calling 1-800-999-3371 (TTY 711), select option 0, or email at delawarepret@gainwelltechnologies.com to confirm your registration for each NPI/taxonomy/service location. 
  • Delaware First Health receives your enrollment status directly from DMAP.
  • Providers do not have to request that Delaware First Health “align” to your enrolled record. The alignment process does not impact our processing of claims.

What Can Providers Do To Avoid CCA Claim Denials

  • Confirm you are registered with Gainwell
  • Download your latest custom report in our provider portal to view the unregistered NPI/taxonomy/service locations submitted to us on claims and take any necessary action. 
  • Bill as you are registered.
  • Register new NPI/taxonomy service locations in advance.
  • Review the explanation of payment and remark codes for any informational remarks and take action to become compliant.

My Claims Denied for CCA, Now What

  • Review the Explanation of Payment remark/denial codes to understand CCA denial reasons.
  • If the CCA denial is due to a missing taxonomy, submit a corrected claim with the taxonomy that is registered.
  • If the CCA denial is due to not being registered, and your application with DMAP was in process prior to October 1, 2024, complete your registration of your existing application. Once the record has been updated by Gainwell DFH will automatically reprocess your claims, no further action is needed by you.
  • If the CCA denial is due to not being registered and you have not started a registration, complete an application as soon as possible. Claims with unregistered NPI/taxonomy/service locations for dates of service after 10/1/24 are not payable under the DMMA guidance. Eligible claims will pay as of the effective date of the provider registration of DMAP.

Thank you for all you do for our members. If you have any additional questions, reach out to your Provider Engagement Administrator (click here for the territory list) or email DE_ProviderEngagement@delawarefirsthealth.com