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Provider Information and Forms

Provider Information and Forms

  1. Provider Conduent EDI Gateway Authorization Form for Billing Agents and Clearinghouses

  2. Conduent EDI Provider Enrollment Form

  3. Prescription Order Form (POF)

  4. DC EAPG Never Pay List Eff 10/1/2019 DCO19018

  5. DC EAPG Grouper Settings Eff 10/1/2019 DCO19019

  6. DC EAPG Relative Weights Eff 10/1/2019 DCO19021

  7. DC EAPG IP Only List Eff 10/1/2019 DCO19020

  8. DC Specialty Hosp DRG Pricing Calculator Eff 10-1-2017 DCSI17023

  9. DC 2017 Fee Schedule Pricing Update Eff 1/1/2017

  10. TPL Payments

  11. DC EAPG Information on EAPGs Eff 10/1/2019 DCO19006

  12. DC EAPG FAQ Eff 10/1/2019 DCO19004

  13. DC Specialty Hosp DRG Pricing Calculator Eff 10-1-2019 DCS19014

  14. HPV Vaccine Reminder

  15. DC Nursing Facility Cost Report Instructions

  16. ASC Fee Schedule (PDF)

  17. DC EAPG Never Pay List Eff 01/01/2018 DCO17059

  18. DC MEPD Update

  19. ASC Fee Schedule (Excel)

  20. New EDI URL Sites

  21. Crossover Pricing Logic

  22. DC EAPG Never Pay List Eff 10/1/2016 DCO16024

  23. DC Specialty Hosp DRG Pricing Calculator Eff 10/1/2016 DCSI16033

  24. DC APR-DRG FAQ Eff 10/1/2018 DCI18004

  25. DC EAPG Never Pay List Eff 10/1/2018 DCO18021

  26. DC Medicaid Beneficiary Disclosure and Commitment to Take Hepatitis C Medications

  27. Conflict-Free Case Management Self-Attestation Form

  28. DC EAPG Grouper Settings Eff 10/1/2018 DCO18022

  29. DC EAPG FAQ Eff 10/1/2018 DCO18005

  30. DC EAPG Information on EAPGs Eff 10/1/2018 DCO18006

  31. DC Specialty Hosp FAQ Eff 10/1/2018 DCS18006

  32. DC Specialty Hosp DRG Pricing Calculator Eff 10-1-2018 DCS18028

  33. ICD-10 Emergency Codes Listing

  34. DC APR-DRG FAQ Eff 10/1/2017 DCI17006

  35. DC EAPG IP Only List Eff 10/1/2017 DCO17042

  36. DC Specialty Hosp DRG Calculator Instructions Eff 10/1/2016 DCSI16034

  37. DC EAPG Never Pay List Eff 10/1/2017 DCO17043

  38. DC EAPG Relative Weights Eff 10/1/2017 DCO17045

  39. DC Specialty Hosp FAQ Eff 10/1/2017 DCS17013

  40. FQHC Quick Reference Guide

  41. DC EAPG FAQ Eff 10/1/2016 DCO16032

  42. FQHCs Payment Methodology Frequently Asked Questions

  43. Conduent EDI Gateway Pharmacy Registration

  44. Hospice Election and Physician Certification

  45. DC Specialty Hosp DRG Calculator Instructions Eff 10-1-2017 DCSI17024

  46. DC EAPG Grouper Settings Eff 10/1/2017 DCO17044

  47. DC APR-DRG Pricing Calculator Eff 10/1/2018 DCI18018

  48. DC EAPG Relative Weights Eff 10/1/2018 DCO18023

  49. DC EAPG IP Only List Eff 10/1/2018 DCO18024

  50. DC EAPG Relative Weights Eff 10/1/2016 DCO16035

  51. DC EAPG Information on EAPGs Eff 10/1/2016 DCO16033

  52. DC EAPG Information on EAPGs Eff 10/1/2017 DCO17029

  53. DC Specialty Hosp FAQ Eff 4/5/2016

  54. DC EAPG Grouper Settings Eff 10/1/2016 DCO16034

  55. 719A Prior Authorization Request Form

  56. DC Specialty Hosp FAQ Eff 10/1/2016 DCSI16032

  57. DC EAPG IP Only List Eff 10/1/2016 DCO16029

  58. DC APR-DRG FAQ Eff 10/1/2016 DCI16017

  59. DC APR-DRG Pricing Calculator Eff 10/1/2016 DCI16024

  60. DC EAPG FAQ Eff 10/1/2017 DCO17027

  61. DC Nursing Facility Cost Report Form

  62. DC Specialty Hosp FAQ Eff 10/1/2019 DCS19004

  63. DC APR-DRG FAQ Eff 10/1/2019 DCI19005

  64. Consent For Sterilization - Spanish - HHS 687-1

  65. Consent For Sterilization - English - HHS 687

  66. Hospice Discharge Form

  67. DC Alliance Formulary List

  68. DC APR-DRG Pricing Calculator Eff 10/1/2017 DCI17036

  69. DC APR-DRG Pricing Calculator Eff 10/1/2019 DCI19016