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