What happens if a provider’s certification expires or they do not follow the guidelines?

If a provider’s certification expires or they repeatedly fail to follow the medical guidelines, they may lose the benefits of certified status. They may be decertified, which means their treatment no longer receives a presumption of reasonableness and may require more preauthorization or UR review. The state may also refuse to renew certification until issues are corrected.

Source File: WorkersComp FAQ 5-16-2025
Law Reference: 19 Del. C. §2322D(g); §2322F(j)