Affordable Care Act
Welcome to the Affordable Care Act (ACA) informational page.
This site is dedicated to informing the healthcare community of the upcoming changes required under the ACA. You will find informational links to various rule changes affecting your business. You will also have the opportunity to submit and review questions and answers. These links will provide additional support to your practice as we transition under the new regulations and procedures.
Section 6401 of the Affordable Care Act
Section 6401 of the Affordable Care Act provides enhanced Program Integrity provisions regarding Provider Screening and Enrollment.
On February 2, 2011, the Centers for Medicare and Medicaid Services published a Final Rule in the Federal Register regarding Medicare, Medicaid, and Delaware Healthy Children Program (DHCP) for provider screening. This Rule implemented provisions of the Patient Protection and Affordable Care Act (ACA). Please click the links below to review the rules and requirements in regards to provider screening and enrollment requirements as they pertain to Medicare, Medicaid and CHIP providers.
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 application so that DMAP may identify providers who only write orders, referrals, and prescriptions. Enrollment is required so that payments can be made for claims related to member services. This requirement does not apply to providers who are enrolled with the Delaware managed care organizations.
Did you know?
The Centers for Medicare and Medicaid Services (CMS) requires States to deny claims from providers who are not enrolled in the State's 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!