Clinical Coverage & Payment Policy Updates

Date: 01/31/25

Delaware First Health reviews all clinical and payment policies at least annually. This review is done to ensure medical necessity review criteria is current and appropriate for members and the scope of the services. On a quarterly basis, prior to updates, policies are reviewed and approved by Delaware First Health’s Quality Improvement and Utilization Management Committee (QI/UMC).

This announcement reflects all revised and updated policies. The full list of policies are on the Clinical and Payment Policies section under Provider Resources. 

Please reach out to your Provider Engagement Administrator if you have any questions.

Policy Updates: Effective: Tuesday, April 1st, 2025

CLINICAL PAYMENT POLICIES WITH CHANGES

• Endometrial Ablation CP.MP.106
• Allergy Testing and Therapy CP.MP.100
• Thyroid Insulin Tests in Ped CP.MP.154