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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.

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.

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.

 

 

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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