Manuals, Forms and Resources
Manuals
- Drug Formulary List (PDF)
- Drug Formulary (machine readable)
- Drug Formulary (searchable)
- Member Handbook
- Provider Billing Manual (PDF)
- Provider Manual (PDF)
Forms
- Behavioral Health Notification of SUD Admission (PDF)
- Certificate of Medical Necessity for Private Duty Nursing and Home Health Aide (PDF)
- Critical Incident Form (PDF)
- Delaware Sterilization Consent Form (PDF)
- Delivery Notification Form (PDF)
- Early Periodic Screening Diagnosis and Treatment (EPSDT)
- Member Outreach Form (PDF)
- Inpatient Medicaid Prior Authorization Form (PDF)
- Missed Shift Report (Excel)
- Notification of Pregnancy (NOP) Form (PDF)
- Outpatient Medicaid Prior Authorization Form (PDF)
- Pediatric Respite Authorization (PDF)
- PCP Change Request Form (PDF)
- Pharmacy Retail Prior Authorization Form (PDF)
- Provider Appeal Form (PDF)
- Weight Watchers Value Added Benefit Baseline Form (PDF)
Provider Contracting and Credentialing
- Behavioral Health Provider Addendum (PDF)
- Contract Request Form (PDF)
- Doula Practitioner Data Form (PDF)
- LTSS Supplementary Addendum (PDF)
- Organizational Provider Application (PDF)
- Ownership and Controls Disclosure Form (PDF)
- Practitioner Data Form (PDF)
- Provider Intake Roster Template (PDF)
- W9 Form (PDF)
Provider Resources
- Doula Quick Reference Guide (PDF)
- Express Scripts Pharmacy Claims Transition FAQs (PDF)
- Medicaid Redetermination Reminder (PDF)
- Payspan Guide (PDF)
- Prior Authorization Guide (PDF)
- Provider Engagement Administrator Contact Information (PDF)
- Provider Welcome Letter (PDF)
- Quick Reference Guide (PDF)
- Secure Provider Portal Guide (PDF)