UPDATE ON RETROACTIVE RATE INCREASE FOR PERSONAL CARE SERVICES (PCS)

Date: 05/08/24

Delaware First Health (DFH) is providing an update on increased rates for personal care services (PCS) providers who bill S5125, S5130, S5150, and T1005 with and without modifier.

We are committed to making the retroactive payments as soon as we can. Over the next four to six weeks, we expect the following to occur:

• DFH is evaluating existing claims and finalizing the amount of the appropriate rate increase per provider. Once those rates are finalized, we will inform each provider the new rate.
• For claims paid with dates of service (DOS) July 1, 2023, through December 31, 2023, DFH will automatically reprocess the claims at the new rate. Providers do not need to take any additional action.
• Our fee schedule will be updated with the new rates effective July 1, 2023, and all new payable claims will be processed and/or reprocessed at the new rate.
• Following the fee schedule update, providers may need to adjust their billed amounts as claims will process based on the lessor of logic (i.e., if billed amount is less than allowable amount payment will equal billed charges).

We will provide updates once rates are finalized and following each estimated reprocessing date(s). If you have any questions, please reach out to Provider Services at 1-877-236-1341 or your assigned Provider Engagement Administrator, Katy Hickman at Kathryn.Hickman@DelawareFirstHealth.com.

Thank you for all you do for our members.