District of Columbia Medicaid — DC Medicaid (Department of Health Care Finance)
| Program name | DC Medicaid (Department of Health Care Finance) |
|---|---|
| Provider portal | https://dhcf.dc.gov |
| FFS claims payer ID | No single canonical ID — routing is fiscal-intermediary-specific. Verify per clearinghouse. |
| Medicaid timely filing | 365 days from date of service |
The federal ceiling for Medicaid timely filing is 12 months under 42 CFR §447.45; most states set a shorter window. Always verify the current policy on the District of Columbia Medicaid provider portal before filing a late-billing appeal.
BCBS licensee in District of Columbia
The Blue Cross Blue Shield Association licensee in District of Columbia is CareFirst BlueCross BlueShield (DC / Maryland / Northern VA). See the CareFirst BCBS payer guide for payer ID, timely filing, prior auth, and appeal procedures.
Top commercial payers in District of Columbia
The dominant commercial insurers operating in District of Columbia, in approximate order of lives covered. Click through for per-payer claims payer IDs, timely filing windows, prior-authorization rules, and appeal procedures.
Medicaid MCOs in District of Columbia
DC Medicaid (Department of Health Care Finance) contracts with the following managed-care organizations to administer Medicaid benefits in District of Columbia. MCO contracts dictate claims routing, prior-auth workflows, and appeal deadlines — route each claim by the member's MCO assignment, not the state FFS payer ID.
Medicare contractor and active LCDs in District of Columbia
Novitas Solutions, Inc. is the Medicare A/B MAC for District of Columbia: Part A and Part B fee-for-service claims from District of Columbia go to it, and its Local Coverage Determinations decide local medical necessity. Durable medical equipment and supply claims go to Noridian Healthcare Solutions, LLC as the DME MAC. Home health and hospice claims are processed by CGS Administrators, LLC. In the current Medicare Coverage Database export, 130 active LCDs from these contractors apply to District of Columbia claims.
- Novitas Solutions, Inc.
A/B MAC (Part A and Part B claims)
- Noridian Healthcare Solutions, LLC
DME MAC (durable medical equipment and supplies)
- CGS Administrators, LLC
Home health and hospice MAC
Selected active Novitas Solutions, Inc. policies for District of Columbia
A selection, not the full list: policies with measured search demand come first, then those on topics that more contractors publish LCDs for.
- L35041 Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds
- L34892 Facet Joint Interventions for Pain Management
- L36920 Epidural Steroid Injections for Pain Management
- L39365 Genetic Testing in Oncology: Specific Tests
- L34914 Assays for Vitamins and Metabolic Function
- L35396 Biomarkers for Oncology
- L35010 Trigger Point Injections
- L35038 Scanning Computerized Ophthalmic Diagnostic Imaging
- L34938 Removal of Benign Skin Lesions
- L35138 Routine Foot Care
- L38916 Respiratory Pathogen Panel Testing
- L35006 Controlled Substance Monitoring and Drugs of Abuse Testing
Equipment, home health and hospice policies that apply in District of Columbia
- L33822 Glucose Monitors
- L33789 Power Mobility Devices
- L33318 Knee Orthoses
- L33686 Ankle-Foot/Knee-Ankle-Foot Orthosis
- L33718 Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea
- L33792 Wheelchair Options/Accessories
- L33797 Oxygen and Oxygen Equipment
- L33942 Physical Therapy - Home Health
Steps to confirm which LCD governs a claim · Every active LCD by contractor
State-specific regulations affecting District of Columbia billing
- DC Code §31-3131 to §31-3135 (prompt pay of clean claims — 30 days electronic)
- DC Code §44-1006 (hospital financial assistance disclosure)
- DC Code §31-3171.01 et seq. (DC Health Benefit Exchange Authority Act of 2011)
Provider licensing & enrollment in District of Columbia
Providers enroll via DC Medicaid Provider Enrollment (dc-medicaid.com, Conduent). DC Medicaid MCOs credential separately via CAQH ProView.
Major health systems headquartered in District of Columbia
| Health system | Headquarters |
|---|---|
| MedStar Health (Washington Hospital Center / Georgetown) | Washington, DC |
| The George Washington University Hospital (UHS) | Washington, DC |
| Howard University Hospital (Adventist HealthCare) | Washington, DC |
| Children's National Hospital | Washington, DC |
| Sibley Memorial Hospital (Johns Hopkins) | Washington, DC |
Frequently asked questions — District of Columbia billing
What is the District of Columbia Medicaid program called?
District of Columbia's Medicaid program is known as DC Medicaid (Department of Health Care Finance). Providers enroll and manage claims through the provider portal at https://dhcf.dc.gov.
What is the District of Columbia Medicaid timely filing limit?
DC Medicaid (Department of Health Care Finance) requires initial claims to be filed within 365 days from the date of service. The federal ceiling is 12 months under 42 CFR §447.45; District of Columbia's 365-day window is set by the state provider manual. Late-billing exceptions may be allowed with good-cause documentation — verify on the state portal before filing an appeal.
Does District of Columbia Medicaid publish a single claims payer ID?
No single canonical claims payer ID is published for DC Medicaid (Department of Health Care Finance). Claims route through the state's fiscal intermediary; look up the correct submitter ID in your clearinghouse directory (Availity, Change Healthcare/Optum, Waystar) and route managed-care claims by the member's MCO assignment.
Who are the largest commercial insurers in District of Columbia?
The dominant commercial payers in District of Columbia include CareFirst BCBS, Kaiser Permanente, UnitedHealthcare, Aetna, Cigna, along with the BCBS licensee CareFirst BlueCross BlueShield (DC / Maryland / Northern VA). Each payer's claims routing, timely filing, and prior-auth rules differ — see the per-payer guides linked above.
What Medicaid managed-care organizations operate in District of Columbia?
DC Medicaid (Department of Health Care Finance) contracts with 3 Medicaid MCOs tracked in the QuickIntell registry, including AmeriHealth Caritas, CareFirst BCBS, Anthem (Elevance Health). MCO contracts determine claims routing and appeal deadlines — route each claim by the member's MCO assignment, not by the FFS payer ID.
What state-specific billing regulations apply in District of Columbia?
District of Columbia has 3 tracked state-level statutes that affect medical billing and RCM: DC Code §31-3131 to §31-3135 (prompt pay of clean claims — 30 days electronic); DC Code §44-1006 (hospital financial assistance disclosure); DC Code §31-3171.01 et seq. (DC Health Benefit Exchange Authority Act of 2011). These sit on top of federal protections such as the No Surprises Act, HIPAA, and 42 CFR §447.45.
Run cleaner claims in District of Columbia with QuickIntell
QuickRCM, QuickAuth, and QuickERA are tuned to DC Medicaid (Department of Health Care Finance) and the commercial payers on this page — eligibility, prior auth, claim scrubbing, and ERA posting all run on real payer rules, not generic adapters.
Disclaimer
This page is operational reference for medical-billing professionals. It is not legal, clinical, or contractual advice. State Medicaid policies, MCO contracts, and payer rules change without notice — always verify against the current provider manual from District of Columbia Medicaid and the member ID card before submission.