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Non-Participating Provider Continuity of Care and Billing Information

Date: 01/12/23

As Delaware’s newest Medicaid Managed Care Organization (MCO), joining Highmark Health Options and Amerihealth Caritas DE, we are committed to ensuring a smooth transition for all our members who may have previously been enrolled with another MCO. Because of this, we want to share important information below so that uninterrupted care continues for our Medicaid members regardless of whether you currently participate in our network:

  • Continuity of Care – For dates of services up to May 1, 2023, DFH will not require a prior authorization in the following circumstances:
    • If you have an authorization from another MCO for an outpatient service; or
    • If you are treating a member in an ongoing course of treatment; and/or
    • If you have an authorization from another MCO for inpatient services.  While a request for an inpatient authorization is being waived, providers must notify DFH of admission for concurrent review and discharge planning.
  • Prior Authorization for New Services – For new outpatient and inpatient services not previously authorized by an MCO, refer to our Pre-Auth Needed Tool on our website to determine if a prior authorization is required. Please call Provider Services at 1-877-236-1341 to request any prior authorizations needed.
  • Reimbursement and Billing Information – The current reimbursement for a non-participating provider is 100% of the Delaware Medicaid Fee Schedule.  DFH’s Payor ID is 68069. Our preferred clearinghouse vendor is Availity, but providers may use their own contracted clearinghouse to submit claims to us. For more information about submitting claims to DFH, please visit our website.

If you are not in our network, we welcome you to join. To get started:

For more information, visit DelawareFirstHealth.com or call us at 1-877-236-1341.