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

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

  5. TPL Payments

  6. HPV Vaccine Reminder

  7. EDI Trading Partner Agreement

  8. DC Nursing Facility Cost Report Instructions

  9. ASC Fee Schedule (PDF)

  10. 719A Prior Authorization Request Form

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

  12. DC MEPD Update

  13. ASC Fee Schedule (Excel)

  14. New EDI URL Sites

  15. Crossover Pricing Logic

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

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

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

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

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

  21. Conflict-Free Case Management Self-Attestation Form

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

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

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

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

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

  27. ICD-10 Emergency Codes Listing

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

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

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

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

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

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

  34. FQHC Quick Reference Guide

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

  36. EDI Gateway Authorization Form for Billing Agents and Clearinghouses

  37. FQHCs Payment Methodology Frequently Asked Questions

  38. Hospice Election and Physician Certification

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  55. Consent For Sterilization - English - HHS 687

  56. DC Nursing Facility Cost Report Form

  57. Hospice Discharge Form

  58. DC Alliance Formulary List

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