Delaware Administrative Code
Title 18 - Insurance
1300 - Health Insurance General Provisions
1319 - Arbitration of Disputes Between Carriers and Primary Care and Chronic Care Management Providers
Section 1319-2.0 - Definitions

"Carrier" or "insurance carrier" means any entity that provides health insurance in this State. "Carrier" includes an insurance company, health service corporation, health maintenance organization and any other entity providing a plan of health insurance or health benefits subject to state insurance regulation. "Carrier" also includes any third-party administrator or other entity that adjusts, administers or settles claims in connection with health benefit plans.

"Chronic care management" means the services in the Chronic Care Management Services program, as administered by the Centers for Medicare and Medicaid Services, and includes Current Procedural Terminology ("CPT") codes 99487, 99489, and 99490.

"Department" means the Delaware Department of Insurance.

"Medicare" means the federal Medicare Program (U.S. Public Law 89-87, as amended) [42 USCS, Ch. 7, XVIII USCS].

"Primary care" means health care provided by a primary care provider.

"Primary care provider" means any physician or individual licensed under Title 24 of the Delaware Code to provide health care, with whom the patient has initial contact and by whom the patient may be referred to a specialist. Examples of a primary care provider include primary care physicians (including an obstetrician - gynecologist pursuant to 18 Del.C. §§ 3342 and 3556, to the extent that provider is serving in the role as a primary care provider), certified nurse practitioners, physician assistants, and other front-line practitioners for chronic care management and primary care who provide primary care in a family, pediatrics, internal medicine, or a geriatrics practice.

"Provider" means a provider of chronic care management or a primary care provider.