All DC residents with Medicaid must renew their coverage this year.
Please help Enrollees receive important renewal information by reminding them to update their contact information with the Department of Health Care Finance (DHCF) at districtdirect.dc.gov.
A comprehensive list of behavioral health resources and guidelines for care.
The Claims Billing Manual provides guidance for billing both professional (CMS-1500) and institutional (UB04) paper and electronic claims. It is not intended to be a comprehensive document of all policies and procedures.
View the guide to implementing the National CLAS Standards.
A listing of clinical practice guidelines for a variety of conditions.
COVID-19 Vaccination and Testing Information
Department of Healthcare Finance (DHCF) approved information provided to enrollees.
COVID-19 Vaccine Provider Enrollment
Information sheet that includes: why you should become a COVID-19 vaccine provider, how to get enrolled and FAQs.
Cultural Competency Provider Training
To satisfy your cultural competency training requirements, please take the "Cultural Competency Provider Training" by clicking on the heading above. If you have questions about this training, please contact MedStar Family Choice District of Columbia Provider Relations at 855-798-4244.
The HEDIS® Resources webpage offers providers information and guidelines on HEDIS measures.
Medical Policies and Procedures
MedStar Provider Assistance Program
MedStar Family Choice DC wants to support providers in their role as caregiver to Enrollees. To that end, the MedStar Provider Assistance Program allows you to securely notify us whenever you need support to engage an Enrollee. Support could be things such as transportation, compliance with appointment scheduling, and information concerning care gaps. The MedStar Provider Assistance Program also provides an opportunity for you to refer Enrollees who may also need care management support or assistance with some Social Determinant of Health (SDOH).
To refer an Enrollee, please complete the MedStar Provider Assistance Referral Form.
Obstetrical Authorization & Initial Assessment (OAIA) Form - Notification of Anticipated Delivery
MedStar Family Choice District of Columbia requires notification of pregnancy immediately following an Enrollee initial prenatal visit. This form contains critical information related to pregnant Enrollees. MedStar Family Choice DC strongly encourages you to complete the OAIA form during the initial prenatal visit and submit the completed form to the Outreach Department via fax at 202-243-6253 within 10 days of completion. Timely submission of the OAIA form is essential for our Care Management Department to effectively coordinate care for our pregnant Enrollees.
Office Laboratory/Pathology Procedure Codes
MedStar Family Choice DC requires laboratory/pathology procedures to be provided by MedStar Family Choice DC participating lab(s). The document linked above lists the procedure codes for labs that can be performed in an office setting.
Peak Performance Incentive Program for Primary Care Providers
The MedStar Family Choice District of Columbia Peak Performance Incentive Program for Primary Care Providers (PCPs) is a value-based payment program designed to incentivize and reward high-quality and high-value care provided to our Enrollees. This program creates opportunities for network PCPs to earn annual performance-based bonus payments of up to six percent of their total outpatient revenue without any payment withholds, penalties, or downsize risk.
Provider Access and Availability Requirements
Learn your requirements regarding member appointments and timeframes, and coverage for after hours.
Provider Education Orientation Slides
New providers can find a variety of details about MedStar Family Choice DC in this training as well as department contact information.
The MedStar Family Choice DC Provider Manual provides information on the DC Healthy Families and DC Healthcare Alliance programs, the requirements of an MCO, and the requirements of providers participating in MedStar Family Choice DC.
Provider alerts and newsletters include important information for all MedStar Family Choice DC providers.
Provider Support
Learn about MedStar Family Choice DC departments and programs that works with and assists providers.
Quality Assurance and Monitoring Programs
To achieve its quality improvement goals, MedStar Family Choice DC participates in a variety of Quality Monitoring programs.
For MedStar Family Choice DC contact numbers and information about pre-authorizations.
Shared Decision Making Tools are available to encourage conversations between our Enrollees and clinicians to facilitate treatment choices. The Mayo Clinic offers online, interactive Shared Decision Making Tools with graphics and comparative choices. These tools cover a wide variety of options such as Anticoagulation Choice, Chest Pain Choice, Diabetes Medication Choice and many others.
Information current as of: