Treat dhcf staff, mfcdc staff, and health care providers and staff, with respect and dignity. Vision no alliance coverage transportation in network emergency only for alliance pharmacy benefits must use the dc pharmacy provider network pharmacies deliveries not covered under alliance behavioral health not covered under alliance. Ffs pbm contractor has implemented a process to do so. Welcome to the district of columbia medicaid pharmacy program website. If you are using a dialup modem, we recommend you use the cd version of the manual. Provider manuals georgia department of community health. If you have questions, call provider services at 18889220007. Medicaid drug authorization forms providers optima health. District of columbia hivaids drug program pharmacy services. Provider manual district of columbia department of health. The list is included in the medstar family choicedc provider manual. Dc hiv pharmacy providers operational protocol author.
Medicaid behavioral health provider directory printable pdf alliance provider directory printable pdf online dental provider portal. Portal attaching the required prescription documentation and the 719a form. If a pharmacy decides to waive the copay for a particular prescription, the dc medicaid. Amerihealth caritas dc has a preferred drug list drug formulary.
Healthcheck, is the dc community name for the early periodic screening, diagnosis, and treatment epsdt guidelines that are used to inform and train health care providers in. As a valued participating provider, you are one of the most essential elements of our fully integrated medicaid health network. The provider lookup database contains all providers with an open dc medicaid provider number. Fqhc billing manual clinic billing manual terms of usage privacy policy browser.
Dc healthy families and dc healthcare alliance provider manual. Community plan care provider manuals for medicaid plans by state 2021 administrative guide for commercial, medicare advantage and dsnp the unitedhealthcare community plan care provider administrative manuals contain helpful information on topics such as prior authorization, processing claims and protocol information, as well as unitedhealthcare. Dec 01, 2020 welcome to our family of health care providers. District of columbia specialty care drug program provider manual hivaids and other specialty care services pharmacy provider network march 20 vincent c. Pharmacy benefits must use the dc pharmacy provider network pharmacies deliveries not covered under alliance behavioral health not covered under alliance emergency services some are not covered by mfc for alliance, and others may be covered by dc medicaid.
We are committed to offering a dental benefit program that ensures access to high quality oral health care. To ensure and improve the health of the younger enrollees in our dc community, carefirst chpdc requires that all providers strictly adhere to healthcheck guidelines. Pharmacy billing manual colorado department of health care. Clarified that claims must be billed using the enrolled pharmacy s national provider identifier npi as the rendering provider and payto provider. We are proud that you will provide dental services to our enrollees directly through your agreement with us. Community plan care provider manuals for medicaid plans by. View patients eligibility status and benefit information. If your doctor gives you a prescription, you must go to a pharmacy in amerihe. Drug formulary printable pdf drug formulary machine readable txt medicaid generic medication requiring 90day supply pdf providers. This provider manual may be changed or updated periodically. Search a list of our formulary to find covered drugs available to medicaid enrollees. Provider data contained within the online directory is updated daily monday through friday.
Performrx, an affiliate of amerihealth caritas dc and a enrollee of the amerihealth caritas family of companies, is the delegated manager of pharmacy services covered by the amerihealth caritas dc health plan. This billing manual is designed to aid providers in billing for these claims. Effective june 7, 2010, idaho medicaid contracted with gainwell technologies externallink, formally known as molina medicaid solutions and dxc to be the mmis claims processing center as well as provide provider training, billing, and operational support for all medicaid providers. You should always ask the provider if he accepts dc medicaid before you get services. This section of the district of columbia medicaid provider manual. It is only by partnering with providers, such as yourself, that we can truly achieve those goals. For district of columbia providers medstar family choice. See the provider administrative and billing manual regarding enrollment procedures.
If there is a form that you feel other providers would find useful to access on this page, please contact us at 202 8211145. All other documents on this website are accessible using a dialup modem. Providers should note specifically, the following differences. Board of public works medicaid provider rate changes for dc. Screening, diagnosis and treatment epsdt provider manual effective january 1, 2021. The information regarding address and telephone for each provider is what is currently on file with the department of health care finance and may not always reflect current changes. Medicaid provider inquiry unit is available to assist you with information regarding billing, recipient eligibility or claims status. Welcome to the district of columbias medicaid pharmacy program. Department of health care finance 441 4th street,n. Preauthorization and utilization management medstar family. District of columbia pharmacy program request for rx prior. District of columbia specialty care drug program pharmacy. Is this medication covered by dc medicaid pharmacy benefit manager.
Medicaid reimbursement for fee for service pharmacies. Also, added covid19 eligible vaccine codes and their corresponding administration codes, along with billing instructions for the vaccines. Information for medicaid providers idaho department of. Jun 15, 2020 welcome to the amerihealth caritas district of columbia dental provider network. Doh medicaid update website provides uptodate changes that may affect your participation in the medicaid program mevs and supplemental documentation this information is not part of your provider manual, however, it may be useful information and is placed here for your convenience. This manual ensures that you have accurate and timely information about medica products, programs, policies and procedures. Provider qualifications provider rights and responsibilities. All medicaid claims as well as childrens special health services cshs, aids drug assistance program adap, aid to the blind, russell silver program, and some county jail claims are processed by the nd medicaid pharmacy system. Outofstate pharmacies must be enrolled with the south carolina medicaid program in order to be. Pharmacy benefits medicaid enrollees amerihealth caritas. For district of columbia medstar family choice providers, learn more about clinical practice guidelines, pharmacy guidelines, and access to the claim portal. Preferred drug list and the pharmacy billing manual.
Remember that not all doctors, dentists and other providers accept medicaid. You can call the dc clinical line at 18002734962 q. Covid19 medicaid providers faqs 3162020 to directly access the provider web. This provider manual was created to assist you and your office staff with providing services to our enrollees, your patients. Participating providers of services in the medicaid program must comply with the requirements of title vi of the civil rights act of 1964 and section 504 of the. Pharmacy benefits providers amerihealth caritas district. The administrative manual is a resource for all clinic and facility staff, including physicians and other health care providers, nurses, and all business staff. Eyewear and contact lens requests may be submitted via the qualis health provider. As a provider, you agree to use this provider manual as a reference pertaining to the provision of medical services for enrollees of amerihealth caritas dc. District of columbia department of health care finance pharmacy preferred drug list pdl effective march 17th, 2021 nonpreferred medications require prior authorization page 1 of 22 analgesics drug class preferred requires prior authorization longacting narcotics clinical criteria apply to this entire therapeutic class embeda. At carefirst chpdc, we stand by our providers in offering exceptional health care to dc locals and their families.
Optima preferred provider organization ppo products are issued and underwritten by optima health insurance company. District of columbia hivaids drug program pharmacy services protocol hivaids pharmacy provider network provider manual september, 2012 program policies and procedures for approved pharmacy service providers to dispense hivaids antiretroviral and other selected medications to eligible and enrolled district of columbia residents. If the drug in question is not listed, contact the dc clinical line at 18002734692. Provider directories and drug formularies amerihealth. If you notice any errors in the directory, please fax, on practice letterhead, the information as it should appear to the attention of provider services at 18664267393. Gray, mayor government of the district of columbia. Medicaid find a doctor, drug or pharmacy amerihealthcaritasdc. District of columbia pharmacy program request for rx prior authorization preferred drug program request date.
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