Get the free Delaware Medical Assistance Provider Enrollment Packet

This document serves as a comprehensive enrollment packet for nursing home providers seeking to enroll in the Delaware Medical Assistance Program, detailing required forms and procedures.

How to fill out delaware medical assistance provider

How to fill out Delaware Medical Assistance Provider Enrollment Packet

1. Obtain the Delaware Medical Assistance Provider Enrollment Packet from the official Delaware Medicaid website.
2. Fill out the Provider Information section with your legal name, business name, and contact details.
3. Complete the Service Location section with the address where you will provide services.
4. Provide information regarding your National Provider Identifier (NPI) and Medicaid provider number, if applicable.
5. Answer all questions regarding your credentials, including any licenses, certifications, and qualifications.
6. Include information about your practice, such as types of services offered and specialties.
7. Review the section on provider ownership and management, listing all owners and managing individuals.
8. Sign and date the application in the designated section to verify the information is true.
9. Submit the completed packet along with any required supporting documents to the specified address.

Who needs Delaware Medical Assistance Provider Enrollment Packet?

1. Healthcare providers who wish to offer services to patients under the Delaware Medical Assistance Program.
2. Doctors, nurses, therapists, and other qualified professionals looking to enroll for reimbursement.
3. Facilities such as hospitals and clinics that want to participate in the Delaware Medicaid program.

People Also Ask about

What is the income limit for Medicaid in Delaware?

You need to provide proof of Identity, U.S. Citizenship and/or Immigration Status and Date of Birth. Effective 7/1/10, citizen children who provide a social security number are not required to provide identity or citizenship documentation if eligible for Child Health Plus.

What is the phone number for Delaware Medicaid provider enrollment?

Medicaid furnishes medical assistance to eligible low-income families and to eligible aged, blind and/or disabled people whose income is insufficient to meet the cost of necessary medical services.

What documentation is required for Medicaid in Delaware?

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 a provider enrollment form?

Provider Enrollment (or Payor Enrollment) refers to the process of applying to health insurance networks for inclusion in their provider panels. For Commercial Insurance networks, this process involves two steps, 1) Credentialing and 2) Contracting.

What is documentation required for Medicaid in Delaware?

You will need to provide verification of your income. You do not need to provide proof of your assets or resources (bank accounts, cars, stocks, etc.) or come into our offices to be interviewed unless you are applying for one of the Long Term Care Medicaid programs or Home and Community Based Services).

What paperwork do you need for Medicaid?

Proof of citizenship or immigration status. Proof of income, like paystubs or W-2s. A verification of what other government benefits you receive. Information about an insurance plan your employer has offered you or an insurance plan you currently have.

For pdfFiller’s FAQs

What is Delaware Medical Assistance Provider Enrollment Packet?

The Delaware Medical Assistance Provider Enrollment Packet is a comprehensive document required for healthcare providers to enroll in Delaware's Medicaid program, allowing them to offer services and receive reimbursement for care provided to eligible individuals.

Who is required to file Delaware Medical Assistance Provider Enrollment Packet?

Healthcare providers, including physicians, hospitals, and other entities that wish to participate in Delaware's Medicaid program and provide services to Medicaid beneficiaries, are required to file the Delaware Medical Assistance Provider Enrollment Packet.

How to fill out Delaware Medical Assistance Provider Enrollment Packet?

To fill out the Delaware Medical Assistance Provider Enrollment Packet, providers should carefully follow the instructions outlined in the packet, providing all necessary information accurately, including personal details, practice information, and any required supporting documentation before submitting it to the appropriate state agency.

What is the purpose of Delaware Medical Assistance Provider Enrollment Packet?

The purpose of the Delaware Medical Assistance Provider Enrollment Packet is to collect essential information from healthcare providers so that they can be approved as providers in the Medicaid program, which enables them to bill for services rendered to eligible beneficiaries.

What information must be reported on Delaware Medical Assistance Provider Enrollment Packet?

The information that must be reported on the Delaware Medical Assistance Provider Enrollment Packet includes provider identification details, practice location, services offered, licensing information, and any relevant certifications or accreditations, along with demographic and contact information.