Physical Health Provider Forms
Prior Authorization Form
Specialty Referral Form
Sterilization Form
Case Management Request Form
Medical Prior Authorization (PA) Form:
A Prior Authorization form is a quick and easy way for Delaware Physicians
Care providers to request approval for medical procedures, admissions or medications.
You can use this form for all prior authorization requests as long as:
- You are an in-network provider
- You are not requesting approval for a procedure scheduled to
take place within the next business day
Requests from out-of-network providers and for procedures scheduled for the next business day
need to be completed by phone. You can reach our PA department at 1-866-543-2167. All services rendered
by an out-of-network provider are subject to prior authorization.
Case Management Request Form:
The Case Management Request Form makes it quick and easy for providers to notify Delaware
Physicians Care about members who need case management. The most common reasons
for case management are:
- High-risk pregnancy
- A child with special health care needs
- A patient with chronic diseases or ongoing care needs
Here are some examples of when to use the Case Management Request form:
- Patient consistently misses appointments
- Diabetic is not consistent with treatment recommendations
- Patient is newly diagnosed with asthma or diabetes
- Pregnant woman is smoking and would like to quit
- New patient is a recent Neonatal Intensive Care Unit (NICU)
discharge
- Child has Attention-Deficit/Hyperactivity Disorder (ADHD) or needs other behavioral health services