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District of Columbia, Department of Health Care Finance

Qualis Health provides a broad range of services for the District of Columbia, Department of Health Care Finance (DC Medicaid).

Our regional office in the District is staffed by people who live in and around the District and whose work helps improve and advance the efficiency, economy, effectiveness and quality of healthcare services provided to enrolled District of Columbia Medicaid clients.

Services We Provide for DC Medicaid

  • Utilization management
    • Prior authorization review
    • Pre-admission review
    • Emergency admission review
    • Continued stay review
    • Retrospective review
    • Long term care review


Please check this page regularly for updates regarding ongoing provider training and resources.

June 5, 2017: New FAQ from DHCF on Long Term Care Nursing Facility Services
The DC Department of Health Care Finance has published a new guide, Eligibility for Medicaid Long Term Care Nursing Facility Services. It provides answers to frequently asked questions about obtaining an assessment and other general information regarding eligibility for nursing facility services. You can also find it on the Provider Resources page in the Provider Notice section.

April 27, 2017: Updated Provider Manual Published
The DC Medicaid Provider Manual has been updated and posted on the Provider Resources page. The Dental Utilization Review Criteria Guidelines (Appendix D of the Provider Manual) are now available as a separate document and are also posted on the Provider Resources page.

February 24, 2017: Join Us in March for an Inpatient Hospice Webinar
Please join us for one of three Inpatient Hospice webinars we’ll be holding in March. During these sessions, we will discuss:

  • District inpatient hospice requirements
  • Submitting reviews to Qualis Health

Visit the Provider Education page for dates, times and instructions.



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Contact Qualis Health

»send an email to Qualis Health Provider Portal Help

»sign up for email alerts

Do not send patient PHI via email.

(800) 251-8890

Contact DC Medicaid

Provider Inquiry Line

(202) 906-8319
(866) 752-9231

»visit the DC Medicaid website

»more contact information