Provider Enrollment
Thank you for your interest in becoming a provider in the Delaware Medical Assistance Program (DMAP) and welcome to the DMAP provider enrollment portal. This portal contains information for fee-for-service (FFS) healthcare providers that submit claims and ordering, referring and prescribing (ORP) providers that do not submit claims.
Did you know?
The Centers for Medicare and Medicaid Services (CMS) requires States to deny claims from providers who are not enrolled in the States Medicaid or CHIP programs. These claims include reimbursement for services rendered, prescriptions, referrals, and orders for lab work and tests. Enroll in the Delaware Medical Assistance Program (DMAP) today!
Ordering, Referring, & Prescribing (ORP) Providers
Ordering and Referring Providers are physicians or other professionals that only order or refer items or services for Medicaid beneficiaries. These providers do not submit claims for reimbursement for any services provided but are required to enroll solely for the purposes of ordering and referring services for Medicaid beneficiaries. Ordering and referring providers are required to complete a limited-capacity enrollment form so that DMAP may identify the providers who write only orders, referrals, and prescriptions. Enrollment is required so that payments can be made for claims related to client services. This requirement does not apply to providers who are enrolled with the Delaware managed care organizations.
Managed Care Only Providers (MCOPs)
In compliance with 42 CFR 438.602 and 42 CFR Part 455, subparts B and E and the 21st Century Cures Act states must screen, enroll, and revalidate MCO network providers according to Program Integrity enhanced screening provisions. MCOPs are required to complete a streamlined provider enrollment application to conduct federally mandated screening activities. This provider enrollment application is mandatory for all MCO providers at initial enrollment, reenrollment, revalidation and for continual participation (registration) with the Managed Care Organization (MCO) under Delaware’s Medicaid Program. In accordance with federal guidelines, the MCOP application process will standardize screening processes for DMAP/fee for service (FFS) providers and MCOPs alike, overall enhancing member services. MCOPs are not required to provide services to DMAP/ FFS members, however the DMAP / FFS enrollment application is available on the Delaware Medical Assistance Portal for providers that chose to participate in both the DMAP/FFS Program and Delaware Managed Care Organization Networks.
High risk providers must successfully enroll in Medicare prior to enrolling with (DMAP).
NPI is only needed if applicable.
When a nurse has an APN license, the RN license is also required.
Please complete each step in the enrollment process. When you have completed all steps of the application, "submit" and "confirm" the application for further processing by the HealthCare system.
You will need the following information to complete your enrollment request:
- Application (this enrollment)
- Tax ID Card/Assignment Letter (include as attachment)
- Provider Contract (noted on Agreement page)
- Business, Professional License, and/or Board Certification (include as attachment)
- Collaborative Agreement (Nurse Practitioner) (include as attachment)
- Drug Enforcement Administration (DEA) License, if applicable (include as attachment)
- Disclosure of Ownership and Control Interest Statement (entered on Disclosure page)
- Electronic Funds Transfer (EFT) Form (entered on EFT page)
- Electronic Remittance Advice (RA) Agreement (entered on ERA page)
- Delaware Title XIX Electronic Claim Submission Form (include as attachment)
- Institutional Fee or Hardship Payment Letter (include as attachment)
- Medicare Certification or Enrollment in another Medicaid State (include as attachment)
- Home Health Agency providers must successfully enroll in Medicare prior to enrolling with DMAP.
- DME providers must successfully enroll in Medicare prior to submitting this DMAP enrollment application.
- Verification of enrollment and or certification with Medicare or another State’s Medicaid Program (or) CHIP.
- NPPES denial notification if provider does not qualify for NPI (include as attachment).
Please click the "Continue" button to start the enrollment application.