Frequently Asked Questions for Providers

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.

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).

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.

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.

Providers are typically notified within 30 business days.

You may contact the Credentialing department at 1-866-423-1444.

Providers may begin the credentialing and contracting process without being enrolled in Delaware Medicaid.

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.

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.

A dedicated Account Executive will be assigned to your practice.

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.

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.

The PCP change will take effect the day the member contacts member services.

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.

Yes. Get an up-to-date list of the drugs that require prior authorization.

Yes. See our online formulary.

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.

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:

• CT/CTA
• MRI/MRA
• PET Scan
• CCTA
• MUGA Scan
• Myocardial Perfusion Imaging (MPI)

Please contact NIA: www.radmd.com or 1-800-424-4791.

Not if you are an "in network provider" and they are an AmeriHealth Caritas Delaware member.

Please contact your Provider Account Executive.