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This document serves as an agreement for providers to submit electronic claims to the Delaware Medicaid Program through a paperless transaction system maintained by HP Enterprise Services, LLC under
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How to fill out delaware title xix electronic
How to fill out Delaware Title XIX Electronic Claim Submission Provider Agreement
01
Obtain the Delaware Title XIX Electronic Claim Submission Provider Agreement form.
02
Read the instructions carefully to understand the requirements.
03
Provide your organization's name, address, and contact information in the designated fields.
04
Fill out the federal tax identification number (TIN) and National Provider Identifier (NPI) where applicable.
05
Indicate the type of services your organization provides by checking the relevant boxes.
06
Review and sign the agreement, ensuring that the authorized representative has signed if necessary.
07
Submit the completed form to the appropriate Delaware Medicaid office either by mail or electronically.
Who needs Delaware Title XIX Electronic Claim Submission Provider Agreement?
01
Healthcare providers who wish to bill Delaware Medicaid for services rendered.
02
Organizations that provide medical, behavioral health, or other health-related services to Medicaid beneficiaries.
03
Providers who want to submit claims electronically for expedited processing.
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People Also Ask about
What is Delaware Medicaid called?
Diamond State Health Plan - Delaware's Medicaid Managed Care Program. The majority of people receiving Medicaid must choose a family doctor who, along with a managed care organization (MCO), will provide or arrange for all your preventive care and medical needs.
How do I contact Delaware Medicaid?
By phone, you can contact Medicaid Customer Relations at 1-800-372-2022 or (302)255-9500 to be directed to the Division of Social Services (DSS) office closest to where you live.
What is a provider enrollment for Medicaid?
Provider Enrollment (or Payor Enrollment) refers to the process of applying to health insurance networks for inclusion in their provider panels.
What is the Medicaid state contract in Delaware?
Delaware's Medicaid state plan is an agreement between the state and the federal government that describes how Delaware administers its Medicaid program. The plan gives an assurance that the state will abide by federal rules and may claim federal matching funds for its program activities.
What is the phone number for Delaware Medicaid provider enrollment?
State of Delaware - Search and Services/Information Enter your assigned tracking number and Tax ID to verify the current status of your enrollment application. For further questions, please contact Provider Services at (800) 999-3371 opt. 0 then 4. * Indicates a required field.
What is Delaware Medicaid called?
Diamond State Health Plan - Delaware's Medicaid Managed Care Program. The majority of people receiving Medicaid must choose a family doctor who, along with a managed care organization (MCO), will provide or arrange for all your preventive care and medical needs.
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What is Delaware Title XIX Electronic Claim Submission Provider Agreement?
The Delaware Title XIX Electronic Claim Submission Provider Agreement is a contract that allows healthcare providers to submit claims electronically to the Delaware Medicaid program for reimbursement for services rendered.
Who is required to file Delaware Title XIX Electronic Claim Submission Provider Agreement?
Healthcare providers who wish to submit electronic claims for services provided to Medicaid beneficiaries in Delaware are required to file the Delaware Title XIX Electronic Claim Submission Provider Agreement.
How to fill out Delaware Title XIX Electronic Claim Submission Provider Agreement?
To fill out the Delaware Title XIX Electronic Claim Submission Provider Agreement, providers must complete all required sections of the agreement form, provide accurate information related to their practice, and ensure to sign and date the document before submission.
What is the purpose of Delaware Title XIX Electronic Claim Submission Provider Agreement?
The purpose of the Delaware Title XIX Electronic Claim Submission Provider Agreement is to formalize the terms under which healthcare providers can submit electronic claims for reimbursement and to ensure compliance with state Medicaid regulations.
What information must be reported on Delaware Title XIX Electronic Claim Submission Provider Agreement?
The Delaware Title XIX Electronic Claim Submission Provider Agreement must report information including provider identification details, NPI (National Provider Identifier), contact information, and specifics of the electronic claim submission process.
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