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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. 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. FQHC Quick Reference Guide

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

  40. FQHCs Payment Methodology Frequently Asked Questions

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

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

  43. Conduent EDI Provider Enrollment Form

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

  45. Hospice Election and Physician Certification

  46. Revised Behavioral Health Transformation Demonstration Program Rates

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

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

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

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

  51. 719A Prior Authorization Request Form

  52. DC Nursing Facility Cost Report Form

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

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

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

  56. Hospice Discharge Form

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

  58. DC Alliance Formulary List

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

  60. DC EAPG Never Pay List Eff 01-01-2022 DCO22002

  61. Change of Ownership Form

  62. EFT Application

  63. Prescription Order Form Instructions

  64. Electronic Prescription Order Form (ePOF)

  65. DC EAPG Information on EAPGs Eff 10-01-2021 DCO21023

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

  67. DC EAPG FAQ Eff 10-01-2021 DCO21018

  68. Single Case Agreement Policies and Procedures

  69. DC APR-DRG FAQ Eff 10-01-2021 DCI21018

  70. Billing and Prior Authorization (PA) Technical Assistance Guidance

  71. DC APR-DRG Pricing Calculator Eff 10-01-2021 DCI21019

  72. DC EAPG Never Pay List Eff 10-01-2021 DCO21020

  73. DC EAPG Grouper Settings Eff 10-01-2021 DCO21021

  74. DC EAPG Relative Weights Eff 10-01-2021 DCO21022

  75. DC EAPG IP Only List Eff 10-01-2021 DCO21019

  76. DC Specialty Hosp FAQ Eff 10-01-2021 DCS21008

  77. DC Specialty Hosp DRG Pricing Calculator Eff 10-01-2021 DCS21007

  78. ICD-10 Emergency Codes Listing - October 2021

  79. Comprehensive List of Providers