Provider Manuals and Forms
Manuals and guides
AmeriHealth Caritas Delaware offers these reference materials to our providers for use when treating our members.
- Provider manual (PDF). Revision table (PDF).
This manual will help you and your office staff provide services to our members.
- Claims and billing guide (PDF).
This manual will help you avoid delays in the processing of your claims.
- Pharmacy reference guide (PDF).
Refer to this guide for quick information about services for providers and pharmacies.
- Provider reference guide (PDF).
Keep this sheet of contact information close by for when you need to give us a call.
- Prior authorization reference guide (PDF).
Refer to this guide for quick information about services requiring prior authorization and how to submit your request.
If you have any questions about these materials or about AmeriHealth Caritas Delaware, call Provider Services at 1-855-707-5818, or contact your Account Executive.
- Behavioral health prior authorization form (PDF)
- Behavioral health outpatient treatment request form (PDF)
- Behavioral Health and Substance Use Disorder Outpatient Treatment Notification Form Child and Adolescent (Ages 17 and Under) (PDF)
- Crisis Intervention Notification Request Form (PDF)
- Inpatient Behavioral health discharge note (PDF)
- Outpatient electroconvulsive therapy (ECT) prior authorization form (PDF)
- Psychological/neuropsychological testing request (PDF)
- Substance use discharge note (PDF)
- Substance use disorder prior authorization form (PDF)
- Transcranial magnetic stimulation request form (PDF)
- Vagus nerve stimulation prior authorization request form (PDF)
- Provider Complaint Form (PDF)
Home Health Agency
- Late and Missed Shifts Reporting Form (.xlsm)
- Providers Guide to Late and Missed Shifts Reporting Form (PDF)
Let Us Know (Rapid Response and Outreach Team)
- Bright Start Breast Pump Prior Authorization Request Form (PDF)
- Obstetrical Delivery Notification Form (PDF)
- Obstetrical Needs Assessment Form (PDF)
- Prior Authorization Request Form (PDF)
- Provider Prior Authorization Guide Physical and Behavioral Health Services (PDF)