Medical Billing Services in Delaware
Delaware is a small state with a payer spread wider than its footprint suggests. Medicaid runs through three managed care organizations, each with its own network and prior authorization rules, and the state’s position on the I-95 corridor means practices regularly see patients who live in Pennsylvania, Maryland, or New Jersey and carry out-of-state coverage. A claim billed without the right plan identified first is a denial waiting to happen.
MedPlus RCM provides medical billing, coding, credentialing, and denial management for Delaware practices of every specialty, built around the state’s actual payers and programs.
Delaware’s payer landscape
Delaware’s Medicaid program is the Diamond State Health Plan (DSHP), a mandatory managed care program in place since 1996. Members enroll in one of three managed care organizations: AmeriHealth Caritas Delaware, Highmark Health Options, and Delaware First Health. Each plan runs its own provider network and authorization rules, and prescription and non-emergency transportation services are covered directly by Medicaid rather than through the plan. A separate Diamond State Health Plan Plus program serves members with complex needs, including dual Medicare and Medicaid eligibles.
Commercial coverage is led by Highmark Blue Cross Blue Shield of Delaware, the state’s largest commercial insurer, alongside Aetna, Cigna, and UnitedHealthcare. Medicare Advantage prior authorization affects a share of schedules, particularly in the retiree-heavy Sussex County beach communities.
What MedPlus RCM handles for Delaware practices
- End-to-end medical billing. Charge entry, claim scrubbing, submission, payment posting, and patient billing. That is the full cycle.
- Medical coding. Certified coders assign current ICD-10, CPT, and HCPCS codes matched to your documentation and specialty.
- Provider credentialing and enrollment. End-to-end enrollment with Diamond State Health Plan organizations, commercial payers, and Medicare, plus re-credentialing maintenance.
- Denial management and recovery. Every denial investigated to root cause, corrected, and appealed with documentation.
- A/R recovery. Aged and outstanding balances audited and pursued, including balances already written off where the appeal window is still open.
- Financial reporting. Clean claim rates, collections, denial patterns, and A/R aging visible by payer and provider.
We serve practices statewide, Wilmington, Dover, and Newark, across specialties including primary care, mental and behavioral health, cardiology, orthopedics, dermatology, and physical therapy.
Results Delaware practices can check
MedPlus RCM maintains a 99% clean claim rate and keeps client accounts receivable under 30 days. Pricing is a performance-based percentage of successfully collected revenue: if you don’t get paid, we don’t get paid. We are 100% HIPAA compliant, and onboarding takes 2 to 4 weeks depending on practice size, with no disruption to your daily cash flow.
Frequently asked questions
Why is Delaware Medicaid billing tricky for such a small state?
Three managed care organizations serve a state with only three counties, and each plan enforces its own network and authorization rules. Add a steady flow of cross-border patients from Pennsylvania, Maryland, and New Jersey, and verifying the plan and the state network before the visit becomes the single most important billing step.
Do you work with Diamond State Health Plan organizations?
Yes. We bill AmeriHealth Caritas Delaware, Highmark Health Options, and Delaware First Health, as well as commercial and Medicare plans.
How long does it take to switch our billing to MedPlus RCM?
Onboarding takes between 2 and 4 weeks depending on practice size, including data migration and payer clearinghouse setup.
What does MedPlus RCM charge?
A performance-based percentage of successfully collected revenue. If you don’t get paid, we don’t get paid.
Get a free financial audit
Find out where your Delaware practice is losing revenue. Request a free financial audit and our specialists will review your claims, denials, and A/R.
