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


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


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


8. TPL Payments


9. HPV Vaccine Reminder


10. DC Nursing Facility Cost Report Instructions


11. Conduent EDI Gateway Pharmacy Registration


12. Compiled Behavioral Health Transformation Demonstration Program Rates


13. ASC Fee Schedule (Excel)


14. Consent For Sterilization - English - HHS 687


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


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


17. Managed Care Provider FAQs


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


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


20. Conflict-Free Case Management Self-Attestation Form


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


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


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


24. Conduent EDI Provider Enrollment Form


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


26. Hospice Election and Physician Certification


27. Revised Behavioral Health Transformation Demonstration Program Rates


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


29. 719A Prior Authorization Request Form


30. DC Nursing Facility Cost Report Form


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


32. Hospice Discharge Form


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


34. DC Alliance Formulary List


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


36. Change of Ownership Form


37. EFT Application


38. Prescription Order Form Instructions


39. Electronic Prescription Order Form (ePOF)


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


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


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


43. Single Case Agreement Policies and Procedures


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


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


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


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


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


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


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


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


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


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


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


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


56. ICD-10 Emergency Codes Listing - October 2022


57. Language Access Request Form


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


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


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


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


62. Comprehensive List of Providers


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


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