Bi-Monthly Network News

Date: 05/07/25

As a reminder, we have officially transitioned away from fax communications as of April 15^th, 2025. All provider updates will now be shared through bi-monthly email notifications like this one. For urgent or time-sensitive alerts — such as system outages or payment delays — we will continue to notify you immediately via email.

At Delaware First Health, we’re committed to keeping you informed with timely, relevant updates that support your work and strengthen our provider network. Each notice includes key announcements, new resources, and helpful reminders — all curated to help you stay current and connected.

Here’s what’s new this month so far:

• New Prior Authorization Requirements (5/2/2025)
  • Effective July 1, 2025, Delaware First Health will require prior authorization for services specific wound care services (Q4202 and Q4164).
•  Free Diabetes Self-Management Workshop (5/5/2025)
  • Delaware First Health invites the public to a free Diabetes Self-Management Workshop hosted at Kingswood Community Center from May 27 to July 1, 2025, aimed at helping participants prevent complications and better manage diabetes. Registration is available at www.HealthyDelaware.org/SelfManagement.
• New Prior Authorization Requirements (5/6/2025)
  • Effective August 1, 2025, Delaware First Health will require prior authorization for infusion therapy code, J1439 and remove prior authorization requirements for several respiratory therapy equipment and genetic testing/mobility aid codes, including A7039, 81257, K0001, A7046, and E0601.
• Reminder: Uploading Supplemental HEDIS Documents in Legacy Portal (5/7/2025)
  • The Quality Improvement team at Delaware First Health reminds providers to upload HEDIS documentation to the correct section of the legacy provider portal and has released a new instruction guide with step-by-step directions and screenshots to support accurate submissions.
• New Provider Resources Now Available
  • Updated Pharmacy Authorization Forms – The Specialty Medication Prior Authorization Form and Prior Authorization Request Form for Prescription Drugs have both been updated with a new fax number and modified instructions. Please review our Pharmacy page for more information.
  • *NEW* Interpreter Request Form – created to streamline and customize requests for interpreter services in office or by video. Please also review the new Language and Interpreter Services page.
  • *NEW* Additional Postpartum Doula Visits Recommendation Form – used to recommend the need for additional postpartum doula visits
  • *NEW* Justification of Abortion Covered by Medicaid Form – form used to certify justification of need for termination of pregnancy

Please note, all of the above forms are located on our Provider Resources/Manuals, Forms and Resources page. This summary is just a snapshot. Please visit the Provider News section of our website for detailed, real-time updates.

We always want to hear from you! If you notice anything missing or have suggestions for additional materials that would support your work, please let us know by submitting feedback through our Provider Feedback Form.

Need Help or Have Questions? Reach out to us through the following channels:

1. Provider Services – 1-877-236-1341, Monday – Friday 8am – 5pm EST
2. General inquiries, email - DE_ProviderEngagement@DelawareFirstHealth.com
3. Contact your dedicated Provider Engagement Account Manager