|
|
|
Please enter your User ID and Password.
Create Account if you don't have an account.
| Effective immediately, all new and re-enrolling providers must complete and submit an EFT application which can be found (opens new window) here. Individual providers who bill under an affiliated group can upload a document waiving enrollment in EFT. |
- Standard Application- Use this application if you are applying to become a new and/or re-enrolling individual physician (including dentist), non-physician practitioner, group, facility or institutional (i.e. hospital, clinic, dialysis, DME etc.) provider for the District of Columbia Medicaid program.
- Mental health/substance abuse providers such as Free Standing Mental Health clinic (FSMHC), Mental Health Rehab Services (MHRS), Recovery Support Services (RSS), Psychosocial Rehabilitation Services (Clubhouse) and other similar behavioral health provider services must receive certification from the Department of Behavioral Health (DBH) prior to submitting a DC Medicaid application through this portal. For questions regarding the mental health/substance abuse provider certification process, please contact the District of Columbia Department of Behavioral Health, Office of Accountability at 202-673-2292.
-
All other individual or group mental health/substance abuse providers such as licensed independent social worker (LISW), licensed professional counselor (LPC), psychologist, licensed marriage and family therapist (LMFT), etc. do NOT have to receive certification from DBH.
- IDD/IFS Waiver- Use this application if you are applying to provide IDD or IFS waiver services. You must fulfill mandatory requirements and received a pre-approval notice from DC Developmental Disabilities Administration (DDA) before initiating this application. For questions regarding mandatory requirements and pre-approval notice please contact DDA at 202-730-1646.
- EPD-Waiver- Use this application if you are applying for elderly and persons with physical disabilities (EPD) waiver provider. You must fulfill mandatory requirements and receive a pre-approval notice from DHCF/Long Term Care before initiating this process. For questions regarding mandatory requirements and pre-approval notice, please contact the District of Columbia Department of Health Care Finance, Long Term Care at 202-442-9533 or dhcf.epdproviderenrollment@dc.gov.
- ADHP 1915(i)- Use this application if you are applying as a 1915(i) state plan home and community-based services provider You must fulfill mandatory requirements and receive a pre-approval notice from DHCF/Long Term Care before initiating this process. Newly enrolling ADHP(i) providers must have a primary service address located in the District of Columbia. For questions regarding mandatory requirements and pre-approval notice, please contact the District of Columbia Department of Health Care Finance, Long Term Care via email at Adultdayhealthprogram@dc.gov
- Streamlined- Use this application if you are applying solely for the purpose of ordering/referring. Medical Residents use this application type.
- Crossover/QMB- Use this application if you are interested in rendering services to Qualified Medicare Beneficiaries (QMB). To provide these services you must enroll in the DC Medicaid program. Please note that participation in this program is limited to rendering services to QMB enrollees ONLY. Also, claims may be submitted up to 365 days from the date the service was rendered.
- Emergency-OOS- Use this application on a one-time basis if you are a provider that has rendered reimbursable services to DC Medicaid-eligible recipients. This application is not intended for providers who will provide services to the general DC Medicaid population. The enrollment term only covers the date(s) of services stated on the submitted medical claim form(s). Claims may be submitted up to 365 days from the date the service was rendered.
- PCA Aide- Use this application if you are a Personal Care Assistant Aide working through a Home Health Agency or EPD Provider.
- Physician Assistant- Use this application if you are a Physician Assistant working with a Physician, Dentist, Podiatrist, etc or a group.
- MCO Only- Use this application if you are an MCO Rendering Provider.
- PDW- Use this application if you are a Participant Directed Worker working though the EPD Waiver, Services My Way program or the IFS Waiver, My Life My Way program.
- PERS- Use this application if you are applying as a Durable Medical Equipment – Personal Emergency Response System (DME-PERS) provider. You must fulfill mandatory requirements per local and federal regulations before initiating this process. For questions regarding mandatory requirements, please contact the District of Columbia Department of Health Care Finance, Long Term Care at 202-442-9533 or dhcf.epdproviderenrollment@dc.gov.
- DBH Streamlined- Use this application if you are an individual rendering provider already affiliated with a Department of Behavioral (DBH) health related program/facility. Please note enrollment is limited to non-billing individual rendering providers who are ONLY affiliated with a DBH related program/facility.
|
|