ENROLLMENT PROCESS TO BECOME AN AUTHORIZED PROVIDER
For the Division of Developmental Disabilities Services
Authorized Provider Application and Enrollment
- STEP 1:
Review "Waiver Services Provider Qualifications" descriptions on this website and determine which service/services you want to provide.
- STEP 2:
Ensure that you meet all qualifications and licensure requirements for the services you want to provide. These are listed on the Waiver Services Provider Qualifications in the section titled "Provider Qualifications".
- STEP 3:
Fill out the "Delaware Medical Assistance Enrollment and Developmental Disabilities Provider Authorization"
(found on the DDDS website or see the link below)
- STEP 4:
Attach all required documents to the enrollment Packet. Supplemental documents that may be needed depending on which service/services you want to provide are:
- NPI (National Provider Identifier) Letter - The provider must submit a copy of their National Provider Identifier assignment letter or electronic verification from CMS/NPPS (National Plan and Provider Enumeration System) or an official EFIO (Electronic File Interchange Organization) if they have obtained an NPI. However, this provider taxonomy is generally not expected to have an NPI and will be assigned a DMAP atypical number if the provider has not obtained an NPI.
- Copy of Tax ID and/or Social Security Card
- Disclosure of Ownership and Control Interest Statement
- Proof of Insurance - General Liability
- Proof of Professional License (if applicable)
- Copy of Delaware Business License (nonprofits exempt)
- Copy or Proof of 501(c)3 designation (nonprofits only)
- Copy of Business Plan (first time enrollees - day and residential providers only). This does not include Clinicians or Shared Living Providers.
- Proof of Homeowner's or Renter's Insurance (Shared Living Providers only)
- Proof of Automobile Insurance (Shared Living Providers Only)
- STEP 5: Send original enrollment packet, along with all required supplemental documents, to the address noted at the end of the application.
Thursday March 29 2012