Provider Information and Forms

1. DC APR-DRG FAQ Eff 10/1/2020 DCI20030


2. DC APR-DRG Pricing Calculator Eff 10/1/2020 DCI20031


3. DC EAPG Never Pay List Eff 10/1/2020 DCO20035


4. 2020 Fee Schedule Update Detail


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


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


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


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


9. CMS Approves DHCF 1915c HCBS Waiver Appendix K Emergency Preparedness Response Plan


10. DC Medicaid Coding for Telemedicine and Coronavirus (COVID-19)


11. ICD-10-CM Official Coding Guidelines Coding encounters related to COVID-19 Coronavirus Outbreak


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


13. TPL Payments


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


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


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


17. HPV Vaccine Reminder


18. DC Nursing Facility Cost Report Instructions


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


20. Conduent EDI Gateway Pharmacy Registration


21. Compiled Behavioral Health Transformation Demonstration Program Rates


22. Crossover Pricing Logic


23. ASC Fee Schedule (Excel)


24. Consent For Sterilization - English - HHS 687


25. DC Specialty Hosp FAQ Eff 10/1/2020 DCS20016


26. DC EAPG Information on EAPGs Eff 10/1/2020 DCO20029


27. Managed Care Provider FAQs


28. DC Specialty Hosp DRG Pricing Calculator Eff 10-1-2020 DCS20015


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


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


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


32. Conflict-Free Case Management Self-Attestation Form


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


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


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


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


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


38. FQHC Quick Reference Guide


39. DC EAPG Grouper Settings Eff 10/1/2020 DCO20031


40. FQHCs Payment Methodology Frequently Asked Questions


41. DC EAPG Relative Weights Eff 10/1/2020 DCO20032


42. DC EAPG IP Only List Eff 10/1/2020 DCO20033


43. Conduent EDI Provider Enrollment Form


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


45. Hospice Election and Physician Certification


46. Revised Behavioral Health Transformation Demonstration Program Rates


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 FAQ Eff 10/1/2020 DCO20028


51. 719A Prior Authorization Request Form


52. DC Nursing Facility Cost Report Form


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


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


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


56. Hospice Discharge Form


57. Level 1 Pre-Admission Screen/Resident Review (PASRR) for SMI, ID, or Related Conditions


58. DC Alliance Formulary List


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


60. DC EAPG Never Pay List Eff 01-01-2022 DCO22002


61. Change of Ownership Form


62. EFT Application


63. Prescription Order Form Instructions


64. Electronic Prescription Order Form (ePOF)


65. DC EAPG Information on EAPGs Eff 10-01-2021 DCO21023


66. DC EAPG Never Pay List Eff 01/01/2021 DCO21001


67. DC EAPG FAQ Eff 10-01-2021 DCO21018


68. Single Case Agreement Policies and Procedures


69. DC APR-DRG FAQ Eff 10-01-2021 DCI21018


70. Billing and Prior Authorization (PA) Technical Assistance Guidance


71. DC APR-DRG Pricing Calculator Eff 10-01-2021 DCI21019


72. DC EAPG Never Pay List Eff 10-01-2021 DCO21020


73. DC EAPG Grouper Settings Eff 10-01-2021 DCO21021


74. DC EAPG Relative Weights Eff 10-01-2021 DCO21022


75. DC EAPG IP Only List Eff 10-01-2021 DCO21019


76. DC Specialty Hosp FAQ Eff 10-01-2021 DCS21008


77. DC Specialty Hosp DRG Pricing Calculator Eff 10-01-2021 DCS21007


78. ICD-10 Emergency Codes Listing - October 2021


79. Comprehensive List of Providers