How to: View and Verify a Member’s Eligibility through the Provider Portal
The following information provides examples of various eligibility designations in the Provider Portal.
Log-In and Search Steps
1. Go to the Delaware Medical Assistance Portal: https://medicaid.dhss.delaware.gov/.
2. Click here to enter the Provider Portal.
![](http://employee.rpromise.com/wp-content/uploads/2019/03/HowtoView.jpg)
3. Log in by entering your User ID, Challenge Question, and Password.
![](http://employee.rpromise.com/wp-content/uploads/2019/03/HowtoView1.jpg)
4. From the Home Page, click the Eligibility tab and then Eligibility Verification.
![](http://employee.rpromise.com/wp-content/uploads/2019/03/HowtoView2.jpg)
5. Perform a search for the member in the top portion of the page.
![](http://employee.rpromise.com/wp-content/uploads/2019/03/HowtoView3.jpg)
The bottom portion of the screen displays the search results with links to the Eligibility Verification Coverage (there can be more than one Coverage).
![](http://employee.rpromise.com/wp-content/uploads/2019/03/HowtoView4-1024x134.jpg)
Eligibility Examples
The following describes the most common eligibility scenarios: QMB, SLMB, Illegal Non-Resident, DHCP (eligible), DHCP (ineligible).
Qualified Medicare Beneficiary (QMB)
1. Click the link, QUALIFIED MEDICARE BENEFICIARY.
![](http://employee.rpromise.com/wp-content/uploads/2019/03/HowtoView5.jpg)
2. Review the Effective Date and End Date for the Coverage and Description listed.
![](http://employee.rpromise.com/wp-content/uploads/2019/03/HowtoView6.jpg)
Note: Partial refers to a partial rather than a full Medicaid program/benefit. For coverage description/service covered, refer to the General Policy manual on the Provider Portal.
Specified Low-Income Medicare Beneficiary (SLMB)
1. Click the link, QUALIFIED BENEFICIARY.
![](http://employee.rpromise.com/wp-content/uploads/2019/03/HowtoView7-1024x194.jpg)
2. Review the Effective Date and End Date for the Coverage and Description listed.
![](http://employee.rpromise.com/wp-content/uploads/2019/03/HowtoView8.jpg)
Illegal Non-Resident – Formerly Known as Emergency Service/Labor & Delivery
1. Click the link, ILLEGAL, NON-RESIDENTS.
![](http://employee.rpromise.com/wp-content/uploads/2019/03/HowtoView9-1024x184.jpg)
2. Review the Effective Date and End Date for the Coverage and Description listed.
![](http://employee.rpromise.com/wp-content/uploads/2019/03/HowtoView10-1024x427.jpg)
Delaware Healthy Children Program (DHCP) – Member IS ELIGIBLE for Date of Service
1. Click the link, DELAWARE HEALTHY CHILDRENS PROGRAM.
![](http://employee.rpromise.com/wp-content/uploads/2019/03/HowtoView11-1024x178.jpg)
2. Review the Managed Care Assignment Details.
MPORTANT: There is a Managed Care Organization (MCO) assignment for the date of service (DOS); therefore, this member is eligible.
![](http://employee.rpromise.com/wp-content/uploads/2019/03/HowtoView12-1024x240.jpg)
Delaware Healthy Children Program (DHCP) – Member Is NOT ELIGIBLE for Date of Service
1. Click the link, DELAWARE HEALTHY CHILDRENS PROGRAM.
![](http://employee.rpromise.com/wp-content/uploads/2019/03/HowtoView13-1024x178.jpg)
2. Review the Effective Date and End Date for the Coverage and Description listed.
IMPORTANT: There is no Managed Care Organization (MCO) assignment for the date of service (DOS); therefore, this member is not eligible.
![](http://employee.rpromise.com/wp-content/uploads/2019/03/HowtoView14-1024x414.jpg)