REINSTATEMENT OF PRIOR AUTHORIZATION REQUIREMENTS FOR EFFECTIVE MAY 1, 2023

Date: 04/10/23

In keeping with our commitment of promoting continuous quality improvement for services provided to Delaware First Health members, effective May 1, 2023, the waiver on prior authorizations for certain services will expire. This means that ordering providers must now obtain prior authorization for certain services that occur on or after May 1, 2023. These include:

• All out-of-network services.
• All non-emergent, advanced, outpatient imaging, cardiac, and interventional pain management (IPM) services managed by NIA Magellan Services.

This decision is consistent with industry-wide efforts to ensure clinically appropriate quality of care and to manage the increasing utilization of services.

If you are unsure as to whether a service requires prior authorization, you can use the preauthorization tool on the Delaware First Health website. Simply visit DelawareFirstHealth.com and click “For Providers.” Then select “Pre-Auth Check” from the left-hand menu.

We appreciate your support and look forward to your assistance in assuring that Delaware First Health members receive services delivered in a quality, clinically appropriate manner.

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