Prior Authorization in Delaware
Soft Home Global provides authorizations submitted ahead of the date of service and chased to a decision for Delaware practices and billing companies at $1,900 per seat per month. Full time, worked during Delaware business hours, inside your own system.
What is specific to Delaware
Delaware runs nearly all of its Medicaid through the Diamond State Health Plan managed care waiver, and because the state is small a practice deals with only a handful of plans statewide.
Delaware’s Medicaid program is Delaware Medicaid (Diamond State Health Plan). Practices with a meaningful Delaware Medicaid (Diamond State Health Plan) mix usually need it worked as its own queue rather than mixed into commercial follow-up, because the submission path, the timely filing window and the appeal route are all different.
Medicare here is adjudicated by Novitas Solutions, jurisdiction JL — shared with Maryland, New Jersey and Pennsylvania. CMS publishes the jurisdictions; checked September 2026.
What a prior authorization seat does in Delaware
Submitted before the date of service and chased through the payer's decision window.
An authorisation found after the visit is a write-off, not a denial to appeal. In Delaware the work is submitting ahead of scheduling and chasing the decision, against a payment clock that starts only once a clean claim lands.
- Authorizations submitted ahead of scheduling, not after
- Status chased rather than waited on
- Peer-to-peer reviews scheduled when required
- Clinical documentation gathered before submission
- Expiring authorizations flagged before they lapse
- Worked during Delaware business hours, not queued overnight
For the statute behind all of this — Delaware’s prompt-pay deadline, its Medicaid filing limit, and the wrinkle that catches people out here — see the Delaware billing page.
Delaware Medicaid (Diamond State Health Plan), in practice
Comprehensive risk-based managed care: KFF's 2024 table records 219,167 Delaware Medicaid enrollees in "comprehensive risk-based managed care" (about the whole program), so providers contract with plan networks rather than billing the state directly. The number and names of the contracted MCOs could not be sourced from a reachable official page. Source: KFF
Delaware limits a carrier to one additional-information request per claim, and starts a short second clock once you answer it: "A carrier may make only one request under this subsection in connection with a claim" and "A carrier who requests information under this subsection shall take action under sections 6.1.1 through 6.1.3 within 15 days of receiving properly requested information." (18 Del. Admin. Code 1310-6.2). Practical effect: a Delaware carrier cannot legitimately run a chain of serial documentation requests to stall a claim, and the payer owes an adjudication 15 days after your records go in. Source: Cornell Legal Information Institute
For authorisations it decides who you ask. A carve-out means the rules, the portal and the turnaround belong to a different administrator from the one handling the rest of the member’s care, and an authorisation obtained from the wrong one is not an authorisation.
Working Delaware hours
Delaware runs on Eastern time, 10 hours behind our floor in Rawalpindi. To be at a desk for your nine to five, the shift here runs 7pm to 3am, and 6pm to 2am once the clocks go forward. Pakistan does not observe daylight saving, so the shift moves on this side rather than yours.
That is the part that decides whether follow-up happens at all: a payer’s phone lines are open on Delaware hours and nobody else’s.
What it costs in Delaware
$1,900
Per seat, per month, in US dollars — $22,800 a year for one full-time person, forty hours a week, on Delaware hours. No annual contract, no percentage of collections, no setup fee and no software to buy. Seat prices across all roles in Delaware run $1,500 to $2,500; the full list is published.
That is the entire invoice. Run your own figures against a percentage vendor or a hire rather than take ours.
Getting started in Delaware
About a week from a signed agreement to a person working your queue, and that week of training is not billed on top. The week, step by step, and what is signed before anyone has access.
If working with staff outside the United States is new to your practice, see how a medical billing company structures that seat and why offshore medical billing does not have to mean losing visibility into the work.
Questions
Do you work with Delaware practices?
Yes. Delaware accounts are worked during Delaware office hours rather than queued overnight, because a payer's phone lines are open then and at no other time.
What is different about Delaware?
Delaware runs nearly all of its Medicaid through the Diamond State Health Plan managed care waiver, and because the state is small a practice deals with only a handful of plans statewide.
Which Medicare Administrative Contractor covers Delaware?
Novitas Solutions, the A/B MAC for jurisdiction JL. Medicare Advantage and commercial plans run their own authorizations; for traditional Medicare, the hospital outpatient services on CMS’s prior authorization list are reviewed by this MAC.
When does a Delaware payer have to pay a clean claim?
30 days after receipt of a clean claim for the carrier to pay in full, pay in part with written explanation, deny in writing, or request additional documentation; then 15 days to act after the requested information arrives. No electronic/paper split. The authorization gets the service approved; this is the deadline for paying the claim that follows it, once that claim is clean.
How fast must Delaware Medicaid (Diamond State Health Plan) decide a prior authorization?
Under the federal CMS-0057-F rule, from 1 January 2026: 72 hours for an expedited request and seven calendar days for a standard one, for Medicaid fee-for-service and Medicaid managed care plans alike, counted in calendar time whether the request went by portal, fax or phone. The calculator at softhomeglobal.com/prior-auth-deadline works out the date.
How much does prior authorization cost in Delaware?
$1,900 per seat per month — $22,800 a year for a full-time person, forty hours a week. Every seat price is published at softhomeglobal.com/pricing.
What hours will somebody actually be working our Delaware queue?
Delaware is on Eastern time, 10 hours behind Rawalpindi. The shift here runs 7pm to 3am so your seat is at a desk for your full working day, shifting to 6pm to 2am while daylight saving is in force — Pakistan does not observe it, so the change happens on our side.
Do you handle Delaware Medicaid (Diamond State Health Plan) as well as commercial payers?
Yes, and as its own queue rather than mixed into commercial follow-up. Delaware Medicaid (Diamond State Health Plan) has its own submission path, its own filing window and its own appeal route, and working it in the same worklist as commercial claims is how the deadlines get missed.
Is this a percentage of what you collect?
No — a flat monthly rate per seat, published at softhomeglobal.com/pricing. A percentage bills you most in your best month and points the vendor at the easy accounts.
More for Delaware
Next step
One seat on your Delaware work
Twenty minutes on a call is enough to tell whether this fits. If it does not, I will say so.
Or write to ops@softhomeglobal.com