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Provider Information and Forms
Provider Information and Forms
DC APR-DRG FAQ Eff 10/1/2020 DCI20030
DC APR-DRG Pricing Calculator Eff 10/1/2020 DCI20031
DC EAPG Never Pay List Eff 10/1/2020 DCO20035
TPL Payments
HPV Vaccine Reminder
DC Nursing Facility Cost Report Instructions
Conduent EDI Gateway Pharmacy Registration
Compiled Behavioral Health Transformation Demonstration Program Rates
DC Specialty Hosp FAQ Eff 10/1/2020 DCS20016
DC EAPG Information on EAPGs Eff 10/1/2020 DCO20029
DC Specialty Hosp DRG Pricing Calculator Eff 10-1-2020 DCS20015
DC Medicaid Beneficiary Disclosure and Commitment to Take Hepatitis C Medications
Conflict-Free Case Management Self-Attestation Form
DC EAPG Grouper Settings Eff 10/1/2020 DCO20031
DC EAPG Relative Weights Eff 10/1/2020 DCO20032
DC EAPG IP Only List Eff 10/1/2020 DCO20033
Conduent EDI Provider Enrollment Form
Provider Conduent EDI Gateway Authorization Form for Billing Agents and Clearinghouses
Hospice Election and Physician Certification
Revised Behavioral Health Transformation Demonstration Program Rates
DC EAPG FAQ Eff 10/1/2020 DCO20028
719A Prior Authorization Request Form
DC Nursing Facility Cost Report Form
Hospice Discharge Form
Level 1 Pre-Admission Screen/Resident Review (PASRR) for SMI, ID, or Related Conditions
DC Alliance Formulary List
DC EAPG Never Pay List Eff 01-01-2022 DCO22002
Change of Ownership Form
EFT Application
Prescription Order Form Instructions
Electronic Prescription Order Form (ePOF)
DC EAPG Information on EAPGs Eff 10-01-2021 DCO21023
DC EAPG Never Pay List Eff 01/01/2021 DCO21001
DC EAPG FAQ Eff 10-01-2021 DCO21018
Single Case Agreement Policies and Procedures
DC APR-DRG FAQ Eff 10-01-2021 DCI21018
DC APR-DRG Pricing Calculator Eff 10-01-2021 DCI21019
DC EAPG Never Pay List Eff 10-01-2021 DCO21020
DC EAPG Grouper Settings Eff 10-01-2021 DCO21021
DC EAPG Relative Weights Eff 10-01-2021 DCO21022
DC EAPG IP Only List Eff 10-01-2021 DCO21019
DC Specialty Hosp FAQ Eff 10-01-2021 DCS21008
DC Specialty Hosp DRG Pricing Calculator Eff 10-01-2021 DCS21007
Retro Eligibility Attestation Form for Long Term Care Services and Supports
Billing and Prior Authorization (PA) Technical Assistance Guidance
IDD Waiver Billing Technical Assistance Report (BTAR) Training
DC EAPG Grouper Settings Eff 10-01-2022 DCO22017
DC EAPG Information on EAPGs Eff 10-01-2022 DCO22019
DC APR-DRG FAQ Eff 10-01-2022 DCI22013
DC APR-DRG Pricing Calculator Eff 10-01-2022 DCI22012
DC EAPG Relative Weights Eff 10-01-2022 DCO22016
DC EAPG FAQ Eff 10-01-2022 DCO22018
e1346 Form
Comprehensive List of Providers
DC Specialty Hosp DRG Pricing Calculator Eff 10-01-2022 DCS22006
DC EAPG Never Pay List Eff 10-01-2022 DCO22015
DC EAPG Never Pay List Eff 01-01-2023 DCO23001
Housing Supportive Services Benefit Tip Sheet - Provider Enrollment & Billing
Referral Form for DME Medical Assistive Devices and Services (DME MADS)
Housing Supportive Services FAQs
ICD-10 Emergency Codes Listing - October 2022
Consent For Sterilization - Spanish - HHS 687
Consent For Sterilization - English - HHS 687