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Provider Information and Forms

Provider Information and Forms

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

  2. Conduent EDI 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. DC Nursing Facility Cost Report Instructions

  8. ASC Fee Schedule (PDF)

  9. 719A Prior Authorization Request Form

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

  11. DC MEPD Update

  12. ASC Fee Schedule (Excel)

  13. New EDI URL Sites

  14. Crossover Pricing Logic

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

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

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

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

  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 10/1/2018 DCO18022

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

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

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

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

  26. ICD-10 Emergency Codes Listing

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

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

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

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

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

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

  33. FQHC Quick Reference Guide

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

  35. FQHCs Payment Methodology Frequently Asked Questions

  36. Conduent EDI Gateway Pharmacy Registration

  37. Hospice Election and Physician Certification

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  54. Consent For Sterilization - English - HHS 687

  55. DC Nursing Facility Cost Report Form

  56. Hospice Discharge Form

  57. DC Alliance Formulary List

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