Get the free Delaware Medical Assistance Provider Enrollment Application

This document serves as an enrollment application for pharmacy providers wishing to participate in the Delaware Medical Assistance Program, requiring specific documentation and ensuring compliance

How to fill out delaware medical assistance provider

How to fill out Delaware Medical Assistance Provider Enrollment Application

1. Obtain the Delaware Medical Assistance Provider Enrollment Application form from the state's Department of Health and Social Services website.
2. Fill in the provider's legal name and business name, if applicable.
3. Provide the provider's National Provider Identifier (NPI) and Tax Identification Number (TIN).
4. Indicate the type of provider (e.g., individual, group, organization).
5. Complete the contact information section, including address, phone number, and email.
6. Include any required professional licenses or certifications relevant to the services provided.
7. Attach any necessary supporting documents as specified in the application instructions.
8. Review all entries for accuracy and completeness.
9. Sign and date the application where indicated.
10. Submit the completed application and any attachments to the specified address or online portal.

Who needs Delaware Medical Assistance Provider Enrollment Application?

1. Healthcare providers who wish to offer services to Medicaid recipients in Delaware.
2. Organizations and individual practitioners needing reimbursement for covered medical services.
3. Providers of medical, behavioral health, dental, and other health-related services that participate in Delaware's Medical Assistance program.

People Also Ask about

How long does Medicaid provider enrollment take?

Once your agreement is signed and returned to the network, you are given an effective date and provider number so that you can begin billing the plan and receiving “In-Network” reimbursement for your claims. Expect networks to take 30 – 45 days for this process (after credentialing is complete).

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 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.

How long does Medicaid approval take in SC?

Generally, it takes up to 45 days for Healthy Connections to determine eligibility, though determination times can increase for certain applicant categories.

How long does it take to process Medicare provider enrollment?

Step 1 Processing Time (Varies by Submission Method): Paper: Approximately 65 days. Web: Approximately 30 days. A certified provider's CMS-855 application is required to go through a multistep review process. Medicare Administrative Contractors (MACs) are responsible for the initial review of the application.

How long does a Medicaid provider application take?

Expect a Medicare application to be completed in 60-90 days if there are no unusual issues.

How long does Medicaid take to apply?

States are required by federal law to approve or deny Medicaid applications within 45 days, or 90 days for applications that require a disability determination.

For pdfFiller’s FAQs

What is Delaware Medical Assistance Provider Enrollment Application?

The Delaware Medical Assistance Provider Enrollment Application is a form that healthcare providers must complete to enroll in the Delaware Medicaid program, allowing them to provide medical services and receive reimbursement.

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

Any healthcare provider intending to participate in the Delaware Medicaid program and provide services to Medicaid beneficiaries is required to file the Delaware Medical Assistance Provider Enrollment Application.

How to fill out Delaware Medical Assistance Provider Enrollment Application?

To fill out the Delaware Medical Assistance Provider Enrollment Application, applicants must gather necessary documentation, complete the required sections of the application form, and submit it along with any supporting documents as specified in the instructions.

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

The purpose of the Delaware Medical Assistance Provider Enrollment Application is to formally enroll healthcare providers in the Medicaid program, ensuring they meet the necessary standards and regulatory requirements to provide services to eligible beneficiaries.

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

The application requires providers to report information such as their personal details, professional qualifications, practice location, tax identification number, licensure information, and any additional documentation that validates their eligibility to participate in the program.