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