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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. Prescription Order Form (POF)

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

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

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

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

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

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

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

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

  14. TPL Payments

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

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

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

  18. HPV Vaccine Reminder

  19. DC Nursing Facility Cost Report Instructions

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

  21. Conduent EDI Gateway Pharmacy Registration

  22. Compiled Behavioral Health Transformation Demonstration Program Rates

  23. Crossover Pricing Logic

  24. ASC Fee Schedule (Excel)

  25. Consent For Sterilization - English - HHS 687

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

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

  28. Managed Care Provider FAQs

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

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

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

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

  33. Conflict-Free Case Management Self-Attestation Form

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

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

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

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

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

  39. ICD-10 Emergency Codes Listing - October 2020

  40. FQHC Quick Reference Guide

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

  42. FQHCs Payment Methodology Frequently Asked Questions

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

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

  45. Conduent EDI Provider Enrollment Form

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

  47. Hospice Election and Physician Certification

  48. Revised Behavioral Health Transformation Demonstration Program Rates

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

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

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

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

  53. 719A Prior Authorization Request Form

  54. DC Nursing Facility Cost Report Form

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

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

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

  58. Hospice Discharge Form

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

  60. DC Alliance Formulary List

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

  62. EFT Application

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