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Provider Information and Forms

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. ICD-10 Emergency Codes Listing - October 2020

  39. FQHC Quick Reference Guide

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

  41. FQHCs Payment Methodology Frequently Asked Questions

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

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

  44. Conduent EDI Provider Enrollment Form

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

  46. Hospice Election and Physician Certification

  47. Revised Behavioral Health Transformation Demonstration Program Rates

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

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

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

  51. DC EAPG FAQ Eff 10/1/2020 DCO20028

  52. 719A Prior Authorization Request Form

  53. DC Nursing Facility Cost Report Form

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

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

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

  57. Hospice Discharge Form

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

  59. DC Alliance Formulary List

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

  61. EFT Application

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

  63. Single Case Agreement Policies and Procedures

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

  65. Prescription Order Form Instructions

  66. ePOF Workflow and Process

  67. Comprehensive List of Providers