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