Delaware Billing Guide for Mental Health Therapists and Psychiatrists
Who pays, where to enroll and which rules change your claims in Delaware, for psychotherapists and psychiatric prescribers.
Last checked October 25, 2026. Reviewed against the official sources listed at the bottom of this page.
This Delaware billing guide covers Medicaid, Medicare, Blue Cross, other private payers and state law for therapists and psychiatrists, with sources and a last-checked date.
Delaware billing guide: how Delaware pays for outpatient care
Delaware Health and Social Services (DHSS), through its Division of Medicaid and Medical Assistance (DMMA), runs the Diamond State Health Plan (DSHP), the state's Medicaid program. Most members are in managed care with three MCOs (AmeriHealth Caritas, Delaware First Health and Highmark Health Options), and providers enroll through the Delaware Medical Assistance Program (DMAP) provider portal; DMAP's policy manual names Gainwell Technologies as fiscal agent.
DMAP fee-for-service claims must be filed within 12 months of the date of service, with late submissions considered when the first submission is documented and falls within 24 months; the MCO filing windows posted by Delaware First Health (120 days for Medicaid) and AmeriHealth Caritas (180 days in network) are much shorter. The Blue licensee is Highmark Blue Cross Blue Shield Delaware (Highmark BCBSD Inc.), a Delaware-only health service corporation affiliated with Highmark Inc.; it is separate from Highmark Health Options, the Medicaid plan. Medicare Part B is handled by Novitas Solutions (Jurisdiction L). DMMA told the Joint Finance Committee on March 2, 2026 that H.R. 1 work requirements start January 1, 2027, with eligibility rechecks every six months.
Who to bill, at a glance
| Payer type | Who you bill | Where to enroll or check rules |
|---|---|---|
| Medicaid | Diamond State Health Plan (DSHP), including DSHP Plus; Section 1115 waiver extended by CMS through December 31, 2028 (per DHSS DSHP page): Delaware Health and Social Services (DHSS), Division of Medicaid and Medical Assistance (DMMA) | Provider enrollment |
| Medicare Part B | Novitas Solutions, Inc. | CMS MAC page |
| Blue Cross Blue Shield | Highmark Blue Cross Blue Shield Delaware (Highmark BCBSD Inc., formerly Blue Cross Blue Shield of Delaware) | See the Blue Cross section below |
Delaware Medicaid and how to bill it
This Delaware billing guide starts with Medicaid, because it decides who pays and how you file.
Managed care for most members. DHSS says DSHP benefits are mostly delivered through an MCO under state contract; members not enrolled in an MCO include people eligible for Medicare, nursing facility or ICF/IID residents, people in HCBS waiver programs, certain non-citizens, people with military health insurance, and presumptively eligible pregnant women.
AmeriHealth Caritas says it administers behavioral health directly; Delaware First Health's guide lists Medicaid behavioral health prior authorization fax lines but names no vendor.
| Item | What to know |
|---|---|
| Agency | Delaware Health and Social Services (DHSS), Division of Medicaid and Medical Assistance (DMMA) |
| Claims or fiscal agent | Gainwell Technologies, named fiscal agent in the DMAP General Policy Manual. Fee-for-service claims go through the DMAP Provider Portal (837 upload or online entry); Delaware First Health notes Gainwell handles DMAP registration questions. |
| Provider enrollment | Official enrollment page |
| Manual or fee schedule | Official manual or fee schedule |
| Work requirement | DMMA's FY 2027 Joint Finance Committee presentation (March 2, 2026) refers to the 'H.R. 1 work requirements for January 1, 2027' and says eligibility must be rechecked every six months rather than annually. |
Managed-care plans and carve-outs
| Plan or entity | Role in behavioral health |
|---|---|
| AmeriHealth Caritas Delaware | Listed by DHSS as an MCO. Plan says it has served Delaware since 2018 and integrates and administers behavioral health directly. |
| Delaware First Health (Centene) | Listed by DHSS as an MCO (DHSS news release of 2022-07-12 names Centene's Delaware First Health). |
| Highmark Health Options | Listed by DHSS as an MCO (DHSS news release calls it Highmark Health Options Blue Cross Blue Shield, a partner since 2015). |
Timely filing (DMAP General Policy Manual, section 1.19): claims must be submitted no later than twelve months from the date of service; Medicare/other-insurance claims are considered up to six months after the provider gets notice of that claim's disposition; late submissions are considered if the initial submission can be documented and falls within 24 months of service; a paid claim may be adjusted up to two years from service; voids and negative adjustments may be submitted within five years of payment; claims should be acknowledged by Gainwell within four weeks or resubmitted.
Medicare Part B in Delaware
For Medicare, this Delaware billing guide names your contractor and the current telehealth rules.
As of 2026-10-25, per the CMS Telehealth FAQ (updated 10/8/26): Medicare telehealth flexibilities run through December 31, 2027, including audio-only in the home.
| Item | What to know |
|---|---|
| Contractor | Novitas Solutions, Inc. |
| Jurisdiction | Jurisdiction L (JL): Delaware, District of Columbia, Maryland, New Jersey and Pennsylvania (plus Part B for Arlington and Fairfax counties, Fairfax and Falls Church cities and Alexandria city in Virginia). |
| Source | CMS.gov MAC page |
Blue Cross Blue Shield in Delaware
This part of the Delaware billing guide names the exact Blue Cross licensee, because Blue plans never share rules.
Blue Cross Blue Shield is a federation of independent companies, so one licensee's rules never apply to another. Here is who holds the Blue license in Delaware.
| Licensee | Parent or affiliation | Where it applies | Provider resources |
|---|---|---|---|
| Highmark Blue Cross Blue Shield Delaware (Highmark BCBSD Inc., formerly Blue Cross Blue Shield of Delaware) | Highmark Inc., Pittsburgh (affiliate since January 1, 2012, per the Delaware Department of Insurance 2014 exam report) | The DOI exam report says the company is licensed to solicit business as a health service corporation in Delaware only. | Source |
Other private payers and EAPs in Delaware
The Delaware billing guide also covers commercial plans and employee assistance programs.
These commercial payers and plan families most often matter for behavioral health billing in Delaware. Check each payer's current provider manual before you submit.
| Payer | Behavioral health note | Provider resources |
|---|---|---|
| Aetna (commercial, national) | Aetna's health care professionals contact page lists one number, 1-888-MD Aetna (632-3862), for indemnity and PPO-based plans. | Official page |
| UnitedHealthcare / Optum Behavioral Health | UnitedHealthcare Provider Services 877-842-3210; Optum 24/7 behavioral health and substance use support line 877-614-0484 as labeled on the page. | Official page |
| Ambetter Health of Delaware (Marketplace, Delaware First Health family) | Delaware First Health's guide lists Marketplace Provider Services 1-833-919-3214 and a 180-day timely filing limit from date of service; claims go to PO Box 5010, Farmington, MO 63640-5010. | Official page |
Delaware billing guide: state law that changes billing
Use this section of the Delaware billing guide to separate state law from payer policy.
State law sets the floor for commercial plans in Delaware. Medicare and Medicaid rules are covered in their own sections above.
Mental health parity
Delaware's insurance department regulation 1410 requires every carrier issuing a health benefit plan to file a mental health and substance use disorder parity report on department forms. It covers benefit classifications, financial requirements and quantitative limits, and non-quantitative treatment limits such as prior authorization and medical necessity standards. Source
Telehealth coverage and payment parity
18 Del. C. section 3370 (and 3571R for the Chapter 35 plans) was added by 2015 Delaware Laws ch. 80 (HB 69), effective January 1, 2016: covered insurers must cover telemedicine services and, as enacted, reimburse them on the same basis and at least at the same rate as the equivalent in-person service, with no separate dollar caps. Source
Prompt payment and timely filing
Insurance Reg. 1310 requires carriers to act no more than 30 days after receipt of a clean claim (pay, pay the payable part with written reasons, deny in writing, or request needed documentation). If the Commissioner finds a violation the carrier may be ordered to pay with interest at the maximum rate allowable to lenders under Delaware law. Source
Practitioner scope: therapists and prescribers
DMAP enrollment page notes that nurse practitioners need a collaborative agreement and APNs also need an RN license; individual practitioners billing DMAP attach their professional license. Scope of practice for each license type is set by the Delaware Division of Professional Regulation. Source
Not legal advice. Confirm statute details with counsel.
Delaware billing guide: codes and rates
This Delaware billing guide lists only codes and rates confirmed on official pages.
These are the Delaware-specific codes, modifiers and rate items confirmed on official pages.
| Code or item | What to know |
|---|---|
| DMAP timely filing and adjustments | 12 months from date of service; late consideration up to 24 months with documented initial submission; adjustments up to two years from service; voids and negative adjustments within five years of payment (DMAP General Policy Manual, section 1.19). Source |
| DPBHS Medicaid behavioral health billing rules | Claims on CMS-1500 (professional) through the DMAP portal; use current ICD-10-CM; CPT codes are for licensed professionals and HCPCS for unlicensed staff and certain programs; a 15-minute unit needs at least 8 minutes of billable time and minutes from separate dates cannot be combined; claims need the DMES authorization number (begins with 'D'), not the six-digit DPBHS number; follow NCCI edits. Source |
| Delaware First Health claims setup | Payer ID 68069; Medicaid initial claims within 120 calendar days; claims mail to PO Box 8001, Farmington, MO 63640-8001 (guide approval stamp 08062024). Source |
Delaware billing guide: what changed, newest first
Check this Delaware billing guide update log before you rely on an older rule.
| Date | What changed | Source |
|---|---|---|
| 2026-10-08 | CMS Telehealth FAQ updated: Medicare telehealth flexibilities continue through December 31, 2027; an in-person visit requirement for mental health telehealth begins January 1, 2028; RHC/FQHC billing for non-behavioral telehealth moves from G2025 to individual codes on October 1, 2026. | Source |
| 2026-06-01 | CMS issued the Medicaid community engagement interim final rule (CMS-2454-IFC): 80 hours a month of qualifying activity for non-pregnant adults 19-64 in the adult group, states must generally implement no later than January 1, 2027, with verification at application and renewal. | Source |
| 2026-03-02 | DMMA's FY 2027 Joint Finance Committee presentation cited the H.R. 1 work requirements for January 1, 2027 and six-month eligibility rechecks. | Source |
| 2024-10-08 | Delaware Department of Insurance announced the first follow-up MHPAEA exam of Highmark with a $329,000 fine and corrective action plan; findings included preauthorization and non-quantitative treatment limit gaps and denial of medically necessary intensive outpatient treatment. | Source |
| 2023-10-01 | Per Delaware First Health, MCO claims deny for dates of service on or after this date if the provider is not registered, enrolled or engaged with DMAP under the 21st Century Cures Act. | Source |
| 2022-07-12 | DHSS announced the Medicaid managed care organizations for 2023: Highmark Health Options, AmeriHealth Caritas, and Centene's Delaware First Health. | Source |
How do I bill mental health claims in Delaware?
These answers come from the same sources as the rest of this Delaware billing guide.
Delaware Health and Social Services (DHSS), through its Division of Medicaid and Medical Assistance (DMMA), runs the Diamond State Health Plan (DSHP), the state's Medicaid program. Most members are in managed care with three MCOs (AmeriHealth Caritas, Delaware First Health and Highmark Health Options), and providers enroll through the Delaware Medical Assistance Program (DMAP) provider portal; DMAP's policy manual names Gainwell Technologies as fiscal agent. Start with the member's payer type: Medicaid plan, Medicare Part B, a Blue Cross licensee or another commercial plan.
Questions about billing in Delaware
How long do I have to file a Delaware Medicaid claim?
DMAP's General Policy Manual says claims must be submitted no later than twelve months from the date of service. Late claims can be considered if the first submission can be documented and falls within 24 months of service. Managed care plans set their own, shorter windows, such as 120 days at Delaware First Health and 180 days in network at AmeriHealth Caritas, so check each plan's guide.
Which Medicaid plans do Delaware behavioral health providers bill?
DHSS lists three Medicaid MCOs: AmeriHealth Caritas, Delaware First Health and Highmark Health Options. Most members are in managed care, and providers must also be registered or enrolled with the Delaware Medical Assistance Program under the 21st Century Cures Act. Fee-for-service claims go through the DMAP provider portal.
Which company is the Blue Cross plan in Delaware?
Highmark Blue Cross Blue Shield Delaware (Highmark BCBSD Inc.) is the Delaware licensee, affiliated with Highmark Inc. It is separate from Highmark Health Options, which is the Delaware Medicaid plan.
Does Delaware require insurers to cover telehealth?
Yes. 18 Del. C. section 3370 requires covered insurers and plans to cover telemedicine services when the underlying service is covered and the provider is licensed, and the 2015 law as enacted also set payment at no less than the in-person rate.
Does MCM South bill for practices in Delaware?
MCM South currently serves ten states; request a quote to ask about Delaware.
Sources for the Delaware billing guide
Last checked October 25, 2026. Every source below was opened and read on that date.
- DMAP General Policy Manual (DHSS), checked October 25, 2026
- CMS Medicare Telehealth FAQ (updated 10/8/26), checked October 25, 2026
- DMMA FY 2027 JFC presentation (Mar. 2, 2026), checked October 25, 2026
- CMS interim final rule fact sheet: Medicaid community engagement, checked October 25, 2026
- CMS: A/B MAC Jurisdiction L (Novitas), checked October 25, 2026
- DHSS: Diamond State Health Plan, checked October 25, 2026
- DHSS DMMA: managed care page, checked October 25, 2026
- DHSS news release: MCOs selected (July 12, 2022), checked October 25, 2026
- DMAP Provider Portal (Delaware Medical Assistance Portal), checked October 25, 2026
- DMAP provider enrollment page, checked October 25, 2026
- DPBHS Medicaid behavioral health billing guidance 2023, checked October 25, 2026
- Delaware First Health: Cures Act / DMAP page, checked October 25, 2026
Related guides
- State & Regional Billing Guides hub
- In-network vs out-of-network credentialing
- Credentialing and network status
- Mental health parity explained
- Medicaid managed care billing
- Medicare behavioral health billing
- Timely filing in the billing glossary
- Who we serve
- Georgia insurance companies contact guide
- Texas insurance companies contact guide
- Florida insurance companies contact guide
- Tennessee insurance companies contact guide
Billing in Delaware? Let us handle the payer calls.
MCM South bills only mental and behavioral health, for psychotherapists and psychiatrists, in solo and medium-size practices. We currently serve ten states; request a quote to ask about Delaware.
MCM South currently serves practices in ten states: Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois.