Telehealth Billing Services in Delaware
Delaware's telehealth practices face unique billing challenges shaped by Highmark Blue Cross Blue Shield's commercial rules, Delaware Medicaid requirements, and Novitas Solutions Medicare policies. Our AAPC-certified coders specialize in both DE payer rules and telehealth coding complexity.
Why Delaware Telehealth Practices Need Specialized Billing
Delaware's healthcare market includes 3,000+ physicians, and telehealth practices here face a payer market dominated by Highmark Blue Cross Blue Shield on the commercial side and Delaware Medicaid on the public payer side. Medicare claims are processed through Novitas Solutions, which applies its own Local Coverage Determinations that directly affect telehealth procedure coverage and medical necessity requirements. Generic billing teams without DE specific knowledge leave revenue on the table.
Telehealth billing itself is complex. Telehealth billing requires precise modifier and place-of-service coding that varies by payer and state. The distinction between POS 02 (telehealth facility) and POS 10 (telehealth patient home) affects reimbursement rates. Modifier 95 designates real-time audio/video services, while modifier 93 covers audio-only visits. Remote patient monitoring codes 99453-99458 and telephone E/M codes 99441-99443 add further billing opportunities that many practices miss entirely. When you combine this coding complexity with Delaware's specific payer rules, authorization requirements, and 2 Delaware Medicaid managed care plans that each have their own billing rules, you need a team that understands both dimensions. Go Medical Billing provides that expertise at 2.49% of collections, serving telehealth practices from Wilmington to Newark and across Delaware.
Top CPT Codes for Telehealth in Delaware
Our DE coders handle these telehealth codes daily, applying Novitas Solutions Medicare rules and Highmark Blue Cross Blue Shield commercial policies to each claim.
Delaware Payer Challenges for Telehealth
Every DE payer has specific rules for telehealth claims. Here's how we navigate them.
Highmark Blue Cross Blue Shield Telehealth Claims
Highmark Blue Cross Blue Shield processes the largest share of Delaware commercial telehealth claims. We know their DE specific fee schedules, prior authorization requirements for telehealth procedures, and their appeal timelines when claims are denied. POS 02 reimburses at facility rates while POS 10 reimburses at non-facility rates — choosing incorrectly reduces reimbursement by 15-30%.
Delaware Medicaid Telehealth Billing
Delaware Medicaid routes telehealth patients through 2 managed care plans: Highmark Health Options, AmeriHealth Caritas. Each MCO has its own telehealth authorization and billing rules that we manage.
Medicare (Novitas Solutions) Telehealth Coverage
Novitas Solutions processes Medicare telehealth claims in Delaware with its own Local Coverage Determinations. We navigate Novitas Solutions's policies around modifier 95 vs 93 requirements to prevent medical necessity denials.
Denial Prevention for Delaware Telehealth
Common telehealth denials in Delaware include pos 02 reimburses at facility rates while pos 10 reimburses at non-facility rates — choosing incorrectly reduces reimbursement by 15-30% and synchronous audio/video visits use modifier 95, audio-only visits use modifier 93, and payers vary on which they accept. Our team catches these issues before submission and appeals aggressively with DE payer-specific documentation when denials occur.
Get Expert Telehealth Billing in Delaware
Free billing assessment for your DE telehealth practice. See where revenue is leaking.
What We Handle for Delaware Telehealth Practices
Delaware Telehealth Billing Cost Comparison
Hiring an in-house biller with telehealth expertise in Delaware costs $38K-$52K annually in salary alone. Add benefits, software, clearinghouse fees, and office space, and the true cost is even higher. At 2.49% of collections, Go Medical Billing provides an entire team of AAPC-certified telehealth coders and DE payer specialists for a fraction of that cost.
$38K-$52K
In-House Biller Salary
+ benefits, software, space
2.49%
Go Medical Billing Rate
Full team, all services included
60-80%
Typical Cost Reduction
With better results
Related Pages
Explore our Delaware and telehealth billing resources.
Frequently Asked Questions
Fix Your Delaware Telehealth Billing
Call 888-701-6090 for a free billing assessment specific to your DE telehealth practice. We'll show you where revenue is leaking and how to fix it.