Manuals, Forms and Resources
Manuals
- Provider Manual (PDF)
- Provider Billing Manual (PDF)
- Drug Formulary List (PDF)
- Drug Formulary (machine readable)
- Member Handbook
Forms
Delaware First Health Forms
- Behavioral Health Notification of SUD Admission (PDF)
- Notification of Pregnancy (NOP) Form (PDF)
- Outpatient Medicaid Prior Authorization Form (PDF)
- Inpatient Medicaid Prior Authorization Form (PDF)
- Pediatric Respite Authorization (PDF)
- Critical Incident Form (Word)
- Provider Appeal Form (Word)
- Pharmacy Retail Prior Authorization Form (PDF)
- Early Periodic Screening Diagnosis and Treatment (EPSDT) Member Outreach Form
- Delaware Sterilization Consent Form (PDF)
- Certificate of Medical Necessity for Private Duty Nursing and Home Health Aide (PDF)
- Missed Shift Report (Excel)
Provider Contracting and Credentialing
- Contract Request Form
- Organizational Provider Application
- Ownership and Controls Disclosure Form
- Practitioner Data Form (PDF)
- Behavioral Health Provider Addendum
- LTSS Supplementary Addendum
- Practitioner Data Form
- W9 Form (PDF)
Provider Resources
- Quick Reference Guide (PDF)
- Provider Welcome Letter (PDF)
- Prior Authorization Guide (PDF)
- Secure Provider Portal Guide (PDF)
- Payspan Guide (PDF)
- Delaware First Health 2023 Proivder Orientation 05.03.23 (PDF)
- Delaware First Health 2023 Virtual Provider Forums 01.26.23 (PDF)
- Provider Engagement Administrator Contact Information (PDF)