Frequently Asked Questions for Providers
- Is non-emergent transportation covered?
- Does AmeriHealth Caritas Delaware provide interpretation and translation services?
- How do I get paid and how long do I have to wait for payment?
- If Medicaid is the secondary payer will Medicare cross the claim over to us?
- How long will it take to be credentialed or in network?
- How can I check on my status while going through credentialing?
- Do providers need a Delaware MAID number?
- How will I be notified of my credentialing status?
- How is continuity of care managed?
- How can I find out who my Network account Executive is?
- Will members be required to select a Primary Care Physician?
- How does a member change his/her PCP?
- If the member changes PCP, when will the new PCP be effective?
- Are there pharmacy copay's?
- Do specialty drugs require Prior Authorization?
- Is there a formulary?
- How do I obtain prior authorization?
- Do certain Diagnostic services require authorization?
- Do Medicaid patients need a referral?
- How can I obtain a copy of the fee schedule?
Is non-emergent transportation covered?
Yes, this benefit is covered by Delaware Department of Health & Social Services' (DHSS), they can be reached by calling Logisticare Provider Services by calling 1-866-412-3778.
Does AmeriHealth Caritas Delaware provide interpretation and translation services?
Yes, Interpretation and translation, and services for the hearing and visually impaired are free to AmeriHealth Caritas Delaware members. Contact AmeriHealth Caritas Delaware Member Services: 1-844-211-0966 or (TTY: 1-855-349-6281) or DSHP Plus/LTSS Member Services: 1-855-777-6617 or (TTY: 1-855-362-5769).
How do I get paid and how long do I have to wait for payment?
You will receive payment by a check in the mail if you are not set up on EFT. Payment will be transferred to your bank account if you sign up for Electronic Fund Transfer through Emdeon. Clean claims are typically paid within 14 calendar days.
If Medicaid is the secondary payer will Medicare cross the claim over to us?
Providers should submit secondary claims to AmeriHealth Caritas Delaware. We will accept TPL claims with the primary insurer EOB electronically or via paper. Please submit TPL claims within 60 days of the date on the EOB claim. We will be accepting claims directly from Medicare when we are the secondary payer.
How long will it take to be credentialed or in network?
Providers are typically notified within 30 business days.
How can I check on my status while going through credentialing?
You may contact the Credentialing department at 1-866-423-1444.
Do providers need a Delaware MAID number?
Providers may begin the credentialing and contracting process without being enrolled in Delaware Medicaid.
How will I be notified of my credentialing status?
There are three ways to verify eligibility and benefits: AmeriHealth Caritas Delaware Provider Services at 1-855-707-5818, use the automated real time eligibility service and follow the prompts for Member Eligibility. Go through the secure provider portal www.navinet.net, or contact Delaware Enterprise System (DMES) at https://medicaid.dhss.delware.gov/provider.
How is continuity of care managed?
If you have a member who has an existing authorized service, AmeriHealth Caritas Delaware will honor the authorization. For more information, please refer to the provider manual.
How can I find out who my Network account Executive is?
A dedicated Account Executive will be assigned to your practice.
Will members be required to select a Primary Care Physician?
Yes, members have the option to choose a PCP within 15 business days of enrollment. After 30 days, if the member fails to select a PCP, they will be auto-assigned.
How does a member change his/her PCP?
A member can change their PCP by contacting member services. The provider office can call Member Services with the member present to request the change, but the member must give their approval for the change.
If the member changes PCP, when will the new PCP be effective?
The PCP change will take effect the day the member contacts member services.
Are there pharmacy copay's?
AmeriHealth Caritas Delaware charges copays for DSHP member's prescription drugs filled at the pharmacy. The copay is based on the cost of each prescription. The most that members will pay for prescription copays each calendar month is $15.00 total. Once a member meets the $15.00 copay maximum for the calendar month, there will be zero copays for drugs filled for the rest of the calendar month. The copay maximum will start over on the first of each month. If a generic drug costs less than $1.00, the member will pay the lesser cost of the drug.
Do specialty drugs require Prior Authorization?
Is there a formulary?
Yes. See our online formulary.
How do I obtain prior authorization?
Prior authorization can be obtained three ways:
- By form: Providers may need to complete a form before administering some health services to members. The form can be found under Forms.
- By phone: Call our Utilization Management department at 1-855-396-5770 for physical health and 1-855-301-5512.
- By fax: at 1-866-497-1384 and for behavioral health- call 1-855-301-5512 or by fax 1-877-234-4273.
Do certain Diagnostic services require authorization?
Yes, AmeriHealth Caritas Delaware's radiology benefits vendor, National Imaging Associates, Inc. (NIA), provides utilization management review and authorization for non-emergent, advanced, outpatient imaging procedures: Services managed and authorized by NIA include outpatient:
- PET Scan
- MUGA Scan
- Myocardial Perfusion Imaging (MPI)
Please contact NIA: www.radmd.com or 1-800-424-4791.
Do Medicaid patients need a referral?
Not if you are an "in network provider" and they are an AmeriHealth Caritas Delaware member.
How can I obtain a copy of the fee schedule?
Please contact your Provider Account Executive.