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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


Announcements

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

June 5, 2018: New Reference for Service Authorization Time Spans
We’ve posted a new document that lists prior authorization/approval time spans and services by review type. “Time Spans for Prior Authorizations and Approval Letters” provides a quick way to look up the approval period for many of the services Qualis Health reviews. You can also find it on the Provider Resources page under “Provider Manual & Appendices.”

April 17, 2018: New Materials Posted for Dental, Hospice and ICF/IID Services
Our Provider Resources page has new checklists, forms and information related to dental, hospice and ICF/IID services.


January 31, 2018: Form 1728 Updated
DHCF form 1728 Intermediate Care Facility / Nursing Facility Level of Care has been updated. You can also find a link to it on the Provider Resources page under “Provider Manual & Appendices.”

January 31, 2018: View Slides from Presentation about Inpatient Hospice
The slides from the January 23 Inpatient Hospice presentation are posted on the Provider Resources page under the heading “Presentation Slides.” The session included District inpatient hospice requirements and instructions for submitting reviews to Qualis Health.

 

 

Adobe Acrobat® PDF files can be opened using Adobe Acrobat Reader. If you do not have Reader, you can get it free from the Adobe website.

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