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

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

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

  7. TPL Payments

  8. HPV Vaccine Reminder

  9. DC Nursing Facility Cost Report Instructions

  10. Conduent EDI Gateway Pharmacy Registration

  11. Compiled Behavioral Health Transformation Demonstration Program Rates

  12. Consent For Sterilization - English - HHS 687

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

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

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

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

  17. Conflict-Free Case Management Self-Attestation Form

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

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

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

  21. Conduent EDI Provider Enrollment Form

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

  23. Hospice Election and Physician Certification

  24. Revised Behavioral Health Transformation Demonstration Program Rates

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

  26. 719A Prior Authorization Request Form

  27. DC Nursing Facility Cost Report Form

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

  29. Hospice Discharge Form

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

  31. DC Alliance Formulary List

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

  33. Change of Ownership Form

  34. EFT Application

  35. Prescription Order Form Instructions

  36. Electronic Prescription Order Form (ePOF)

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

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

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

  40. Single Case Agreement Policies and Procedures

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

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

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

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

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

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

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

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

  49. Retro Eligibility Attestation Form for Long Term Care Services and Supports

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

  51. IDD Waiver Billing Technical Assistance Report (BTAR) Training

  52. DC EAPG Grouper Settings Eff 10-01-2022 DCO22017

  53. DC EAPG Information on EAPGs Eff 10-01-2022 DCO22019

  54. ICD-10 Emergency Codes Listing - October 2022

  55. DC APR-DRG FAQ Eff 10-01-2022 DCI22013

  56. DC APR-DRG Pricing Calculator Eff 10-01-2022 DCI22012

  57. DC EAPG Relative Weights Eff 10-01-2022 DCO22016

  58. DC EAPG FAQ Eff 10-01-2022 DCO22018

  59. e1346 Form

  60. Comprehensive List of Providers

  61. DC Specialty Hosp DRG Pricing Calculator Eff 10-01-2022 DCS22006

  62. DC EAPG Never Pay List Eff 10-01-2022 DCO22015

  63. Housing Supportive Services Tip Sheet Provider Enrollment Billing (FINAL)

  64. Housing Supportive Services Benefit Tip Sheet - Provider Enrollment & Billing

  65. Housing Supportive Services FAQs

  66. Referral Form for DME Medical Assistive Devices and Services (DME MADS)

  67. ASC Fee Schedule