Delaware § 3377 Electronic standards for pre-authorization [For application of this section, see 85 Del. Laws, c. 176, § 4]

Delaware Statutes

§ 3377 — Electronic standards for pre-authorization [For application of this section, see 85 Del. Laws, c. 176, § 4]

Delaware § 3377

JurisdictionDelaware

Title18

PartInsurance

Ch. 33HEALTH INSURANCE CONTRACTS

Subch.Pre-Authorization Transparency

This text of Delaware § 3377 (Electronic standards for pre-authorization [For application of this section, see 85 Del. Laws, c. 176, § 4]) is published on Counsel Stack Legal Research, covering Delaware primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook

Del. Code tit. 18, § 3377 (2026).

Text

(a)No later than January 1, 2018, the insurer must accept and respond to pre-authorization requests under the pharmacy benefit through a secure electronic transmission using the NCPDP SCRIPT standard ePA transactions. Facsimile, proprietary payer portals, and electronic forms shall not be considered electronic transmission.

(b)No later than January 1, 2027, an insurer, health-benefit plan, health-service corporation, or utilization review entity must allow for and accept electronic pre-authorization requests and must respond to electronic pre-authorization requests through the same website, mobile application, digital platform, or other method as the electronic pre-authorization request was submitted.

(c)No later than January 1, 2027, an insurer, health-benefit plan, health-service co

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(a) No later than January 1, 2018, the insurer must accept and respond to pre-authorization requests under the pharmacy benefit through a secure electronic transmission using the NCPDP SCRIPT standard ePA transactions. Facsimile, proprietary payer portals, and electronic forms shall not be considered electronic transmission.

(b) No later than January 1, 2027, an insurer, health-benefit plan, health-service corporation, or utilization review entity must allow for and accept electronic pre-authorization requests and must respond to electronic pre-authorization requests through the same website, mobile application, digital platform, or other method as the electronic pre-authorization request was submitted.

(c) No later than January 1, 2027, an insurer, health-benefit plan, health-service corporation, or utilization review entity must establish a provider portal that includes all of the following features:

(1) Electronic submission of pre-authorization requests.

(2) Access to the insurer’s, health-benefit plan’s, health-service corporation’s, or utilization review entity’s applicable medical policies.

(3) Information necessary to request a peer-to-peer review.

(4) Contact information for the insurer’s, health-benefit plan’s, health-service corporation’s, or utilization review entity’s relevant clinical or administrative staff.

(5) For any health-care service that requires pre-authorization that is not subject to electronic submission via the provider portal, copies of applicable forms.

(6) Instructions for the submission of pre-authorization requests if the insurer’s, health-benefit plan’s, health-service corporation’s, or utilization review entity’s provider portal is unavailable for any reason.

(d) Within 12 months following establishment of a provider portal under subsection (c) of this section, the insurer, health-benefit plan, health-service corporation, or utilization review entity may require a health-care provider seeking pre-authorization to submit the request via the provider portal unless 1 of the following exemptions applies:

(1) The portal is not available and operational at the time of attempted submission.

(2) The health-care provider does not have access to the insurer’s, health-benefit plan’s, health-service corporation’s, or utilization review entity’s operational provider portal.

(3) The health-care provider satisfies an allowance by the insurer, health-benefit plan, health service corporation, or utilization review entity for submission other than through the provider portal.