Delaware Medicaid — Delaware Medical Assistance Program (DMAP / Diamond State Health Plan)
| Program name | Delaware Medical Assistance Program (DMAP / Diamond State Health Plan) |
|---|---|
| Provider portal | https://medicaid.dhss.delaware.gov |
| FFS claims payer ID | No single canonical ID — routing is fiscal-intermediary-specific. Verify per clearinghouse. |
| Medicaid timely filing | 365 days from date of service |
The federal ceiling for Medicaid timely filing is 12 months under 42 CFR §447.45; most states set a shorter window. Always verify the current policy on the Delaware Medicaid provider portal before filing a late-billing appeal.
BCBS licensee in Delaware
The Blue Cross Blue Shield Association licensee in Delaware is Highmark Blue Cross Blue Shield Delaware. See the Highmark BCBS payer guide for payer ID, timely filing, prior auth, and appeal procedures.
Top commercial payers in Delaware
The dominant commercial insurers operating in Delaware, in approximate order of lives covered. Click through for per-payer claims payer IDs, timely filing windows, prior-authorization rules, and appeal procedures.
Medicaid MCOs in Delaware
Delaware Medical Assistance Program (DMAP / Diamond State Health Plan) contracts with the following managed-care organizations to administer Medicaid benefits in Delaware. MCO contracts dictate claims routing, prior-auth workflows, and appeal deadlines — route each claim by the member's MCO assignment, not the state FFS payer ID.
Medicare contractor and active LCDs in Delaware
Novitas Solutions, Inc. is the Medicare A/B MAC for Delaware: Part A and Part B fee-for-service claims from Delaware go to it, and its Local Coverage Determinations decide local medical necessity. Durable medical equipment and supply claims go to Noridian Healthcare Solutions, LLC as the DME MAC. Home health and hospice claims are processed by CGS Administrators, LLC. In the current Medicare Coverage Database export, 130 active LCDs from these contractors apply to Delaware claims.
- Novitas Solutions, Inc.
A/B MAC (Part A and Part B claims)
- Noridian Healthcare Solutions, LLC
DME MAC (durable medical equipment and supplies)
- CGS Administrators, LLC
Home health and hospice MAC
Selected active Novitas Solutions, Inc. policies for Delaware
A selection, not the full list: policies with measured search demand come first, then those on topics that more contractors publish LCDs for.
- L35041 Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds
- L34892 Facet Joint Interventions for Pain Management
- L36920 Epidural Steroid Injections for Pain Management
- L39365 Genetic Testing in Oncology: Specific Tests
- L34914 Assays for Vitamins and Metabolic Function
- L35396 Biomarkers for Oncology
- L35010 Trigger Point Injections
- L35038 Scanning Computerized Ophthalmic Diagnostic Imaging
- L34938 Removal of Benign Skin Lesions
- L35138 Routine Foot Care
- L38916 Respiratory Pathogen Panel Testing
- L35006 Controlled Substance Monitoring and Drugs of Abuse Testing
Equipment, home health and hospice policies that apply in Delaware
- L33822 Glucose Monitors
- L33789 Power Mobility Devices
- L33318 Knee Orthoses
- L33686 Ankle-Foot/Knee-Ankle-Foot Orthosis
- L33718 Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea
- L33792 Wheelchair Options/Accessories
- L33797 Oxygen and Oxygen Equipment
- L33942 Physical Therapy - Home Health
Steps to confirm which LCD governs a claim · Every active LCD by contractor
State-specific regulations affecting Delaware billing
- 18 Del. Code §2304(16) (unfair claim settlement practices — prompt pay 30 days electronic clean claim)
- Delaware SB 159 (2019 — protections on certain OON charges)
- 16 Del. Code §1001C (hospital financial assistance / charity care reporting)
Provider licensing & enrollment in Delaware
Providers enroll via Delaware Medical Assistance Portal (DMAP). Diamond State Health Plan MCOs credential separately; CAQH accepted.
Major health systems headquartered in Delaware
| Health system | Headquarters |
|---|---|
| ChristianaCare | Wilmington, DE |
| Bayhealth | Dover, DE |
| Beebe Healthcare | Lewes, DE |
| Nemours Children's Health | Wilmington, DE |
| Saint Francis Healthcare (Trinity Mid-Atlantic) | Wilmington, DE |
Frequently asked questions — Delaware billing
What is the Delaware Medicaid program called?
Delaware's Medicaid program is known as Delaware Medical Assistance Program (DMAP / Diamond State Health Plan). Providers enroll and manage claims through the provider portal at https://medicaid.dhss.delaware.gov.
What is the Delaware Medicaid timely filing limit?
Delaware Medical Assistance Program (DMAP / Diamond State Health Plan) requires initial claims to be filed within 365 days from the date of service. The federal ceiling is 12 months under 42 CFR §447.45; Delaware's 365-day window is set by the state provider manual. Late-billing exceptions may be allowed with good-cause documentation — verify on the state portal before filing an appeal.
Does Delaware Medicaid publish a single claims payer ID?
No single canonical claims payer ID is published for Delaware Medical Assistance Program (DMAP / Diamond State Health Plan). Claims route through the state's fiscal intermediary; look up the correct submitter ID in your clearinghouse directory (Availity, Change Healthcare/Optum, Waystar) and route managed-care claims by the member's MCO assignment.
Who are the largest commercial insurers in Delaware?
The dominant commercial payers in Delaware include Highmark BCBS, Aetna, UnitedHealthcare, Cigna, AmeriHealth Caritas, along with the BCBS licensee Highmark Blue Cross Blue Shield Delaware. Each payer's claims routing, timely filing, and prior-auth rules differ — see the per-payer guides linked above.
What Medicaid managed-care organizations operate in Delaware?
Delaware Medical Assistance Program (DMAP / Diamond State Health Plan) contracts with 2 Medicaid MCOs tracked in the QuickIntell registry, including AmeriHealth Caritas, Highmark BCBS. MCO contracts determine claims routing and appeal deadlines — route each claim by the member's MCO assignment, not by the FFS payer ID.
What state-specific billing regulations apply in Delaware?
Delaware has 3 tracked state-level statutes that affect medical billing and RCM: 18 Del. Code §2304(16) (unfair claim settlement practices — prompt pay 30 days electronic clean claim); Delaware SB 159 (2019 — protections on certain OON charges); 16 Del. Code §1001C (hospital financial assistance / charity care reporting). These sit on top of federal protections such as the No Surprises Act, HIPAA, and 42 CFR §447.45.
Run cleaner claims in Delaware with QuickIntell
QuickRCM, QuickAuth, and QuickERA are tuned to Delaware Medical Assistance Program (DMAP / Diamond State Health Plan) and the commercial payers on this page — eligibility, prior auth, claim scrubbing, and ERA posting all run on real payer rules, not generic adapters.
Disclaimer
This page is operational reference for medical-billing professionals. It is not legal, clinical, or contractual advice. State Medicaid policies, MCO contracts, and payer rules change without notice — always verify against the current provider manual from Delaware Medicaid and the member ID card before submission.