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Delaware Code Title 18. Insurance Code § 3587. Electronic standards for pre-authorization

Current as of January 01, 2026 | Updated by Findlaw Staff

(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.

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Cite this article: FindLaw.com - Delaware Code Title 18. Insurance Code § 3587. Electronic standards for pre-authorization - last updated January 01, 2026 | https://codes.findlaw.com/de/title-18-insurance-code/de-code-sect-18-3587/

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