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Provider Information and Forms

Provider Information and Forms

  1. EDI Gateway Pharmacy Registration Form

  2. EDI Gateway Provider Enrollment Form

  3. Consent For Sterilization - English - HHS 687

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

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

  6. TPL Payments

  7. HPV Vaccine Reminder

  8. EDI Trading Partner Agreement

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

  10. DC Nursing Facility Cost Report Instructions

  11. ASC Fee Schedule (PDF)

  12. 719A Prior Authorization Request Form

  13. DC Nursing Facility Cost Report Form

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

  15. DC MEPD Update

  16. ASC Fee Schedule (Excel)

  17. New EDI URL Sites

  18. Crossover Pricing Logic

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

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

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

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

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

  24. Conflict-Free Case Management Self-Attestation Form

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

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

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

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

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

  30. ICD-10 Emergency Codes Listing

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

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

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

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

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

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

  37. FQHC Quick Reference Guide

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

  39. EDI Gateway Authorization Form for Billing Agents and Clearinghouses

  40. FQHCs Payment Methodology Frequently Asked Questions

  41. Hospice Election and Physician Certification

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  57. Hospice Discharge Form

  58. DC Alliance Formulary List

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