Delaware Statewide Health Information Technology Infrastructure for Real-Time Insurance Verification and Prior Authorizations

Summary

The Delaware Department of Health and Social Services (DHSS) and the Delaware Health Care Commission have launched a new Rural Health Transformation Program (RHTP) initiative to support real-time insurance verification and prior authorization capabilities statewide. Leveraging the Delaware Health Information Network (DHIN) and Smart Health Network, the project provides a shared connection point for participating providers and payers to exchange information using common standards, thereby reducing administrative burdens, improving care coordination, and supporting faster access to care. The initiative is part of the RHTP and specifically aims to decrease administrative workload for providers and increase efficiency in Medicaid and rural healthcare settings. This is a direct partnership, not subject to competitive bidding.

Eligibility

Direct partnership; not a competitive procurement. Project partners are DHIN and Smart Health Network.

Requirements Checklist

• Leverage existing DHIN and Smart Health Network infrastructure to implement statewide real-time insurance verification and prior authorization functionality, improving admin exchange among clinicians, payers, health systems, and patients.

Source Documents