Regulatory Requirements

Prior Authorization Reporting

In an effort to improve transparency in the pre-authorization approval and decline
rates by health plans, Delaware law (Title 18, Subchapter V of the Delaware
Code) now requires the submission of prior authorization data to Delaware Health
Information Network (DHIN) at least twice a year.

Health insurers, health benefit plans and health service corporations are
required to report to DHIN de-identified statistics regarding pre-authorization
approvals, denials and appeals in the specified format [linked below] by January 31st and July 31st of each calendar year. 

Q&A from conference call with DHIN and the Department of Insurance (1/31/18)

Pre-authorization reporting requirements and reporting spreadsheet

Testimonials

“I think it has saved a lot of money particularly for my practice. I’m not getting duplicate faxes sent to me and from other facilities and that’s been a huge resource in terms of time. My staff is not spending time on the phone trying to get results sent. Instead we can just log onto DHIN, verify the patient, and have access to all of that in less than 30 seconds.”

– Sherin Ibrahim-Howett, DO, Sleep and Internal Medicine – The Pearl Clinic

Delaware Health Information Network - Empowering Data-Driven Decisions

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