Provider Information and Forms

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


2. Conduent EDI Provider Enrollment Form


3. Prescription Order Form (POF)


4. DC EAPG Never Pay List Eff 10/1/2019 DCO19018


5. DC EAPG Grouper Settings Eff 10/1/2019 DCO19019


6. DC EAPG Relative Weights Eff 10/1/2019 DCO19021


7. DC EAPG IP Only List Eff 10/1/2019 DCO19020


8. DC Specialty Hosp DRG Pricing Calculator Eff 10-1-2017 DCSI17023


9. DC 2017 Fee Schedule Pricing Update Eff 1/1/2017


10. TPL Payments


11. DC EAPG Information on EAPGs Eff 10/1/2019 DCO19006


12. DC EAPG FAQ Eff 10/1/2019 DCO19004


13. DC Specialty Hosp DRG Pricing Calculator Eff 10-1-2019 DCS19014


14. HPV Vaccine Reminder


15. DC Nursing Facility Cost Report Instructions


16. ASC Fee Schedule (PDF)


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


18. DC MEPD Update


19. ASC Fee Schedule (Excel)


20. New EDI URL Sites


21. Crossover Pricing Logic


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


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


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


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


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


27. Conflict-Free Case Management Self-Attestation Form


28. DC EAPG Grouper Settings Eff 10/1/2018 DCO18022


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


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


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


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


33. ICD-10 Emergency Codes Listing


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


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


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


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


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


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


40. FQHC Quick Reference Guide


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


42. FQHCs Payment Methodology Frequently Asked Questions


43. Conduent EDI Gateway Pharmacy Registration


44. Hospice Election and Physician Certification


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


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


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


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


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


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


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


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


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


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


55. 719A Prior Authorization Request Form


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


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


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


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


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


61. DC Nursing Facility Cost Report Form


62. DC Specialty Hosp FAQ Eff 10/1/2019 DCS19004


63. DC APR-DRG FAQ Eff 10/1/2019 DCI19005


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


65. Consent For Sterilization - English - HHS 687


66. Hospice Discharge Form


67. DC Alliance Formulary List


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


69. DC APR-DRG Pricing Calculator Eff 10/1/2019 DCI19016