Provider Manuals and Forms

Manuals and guides

AmeriHealth Caritas Delaware offers these reference materials to our providers for use when treating our members.

• Provider manual (PDF). Revision table (PDF).
  This manual will help you and your office staff provide services to our members.
• Claims and billing guide (PDF).
  This manual will help you avoid delays in the processing of your claims.
• Pharmacy reference guide (PDF).
  Refer to this guide for quick information about services for providers and pharmacies.
• Provider reference guide (PDF).
  Keep this sheet of contact information close by for when you need to give us a call.
• Prior authorization reference guide (PDF).
  Refer to this guide for quick information about services requiring prior authorization and how to submit your request.

If you have any questions about these materials or about AmeriHealth Caritas Delaware, call Provider Services at 1-855-707-5818, or contact your Account Executive.

Forms

Behavioral health

• Behavioral Health and Substance Use Disorder Outpatient Treatment Notification Form Child and Adolescent (Ages 17 and Under) (PDF)
• Crisis Intervention Notification Request Form (PDF)
• Provider forum 2022 (PDF)
• Prior authorization request form (PDF)
• Substance use services additional information form (PDF)
• Transcranial magnetic stimulation request form (PDF)
• Vagus nerve stimulation prior authorization request form (PDF)

Complaints

• Provider Complaint Form (PDF)
• Provider Claim Refund Form (PDF)

Home Health Agency

• Certificate of Medical Necessity for Private Duty Nursing and Home Health Aid (PDF)
• Late and Missed Shifts Reporting Form (.xlsm)
• Providers Guide to Late and Missed Shifts Reporting Form (PDF)

Let Us Know (Rapid Response and Outreach Team)

• Rapid Response and Outreach Team Member Intervention Form (PDF)

Maternity

• Bright Start Provider Training Guide (PDF)
• Bright Start Breast Pump Prior Authorization Request Form (PDF)
• Obstetrical Delivery Notification Form (PDF)
• Obstetrical Needs Assessment Form (PDF)

Prior Authorization

• Pediatric Respite (PDF)
• Prior Authorization Request Form (PDF)
• Provider Prior Authorization Guide Physical and Behavioral Health Services (PDF)

Quality Management

• Delaware Medicaid critical incident report form (PDF)
• HEDIS Documentation and Guidelines (PDF)

Working with AmeriHealth Caritas Delaware

• Primary Care Provider (PCP) Selection Form (PDF)
• Sterilization Consent Form (PDF)