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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. 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