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