HSCSN Provider Newsletter
HSCSN Network Connector gives you the latest news about HSCSN, practice requirements, and District of Columbia Department of Health Care Finance updates.
- Provider Newsletter - Fall 2016 [PDF - 4.13 MB]
- Provider Newsletter - Spring 2016 [PDF - 2.78 MB]
- Provider Newsletter – Winter 2015 [PDF - 1.27 MB]
HSCSN Provider Manual
HSCSN created this manual to assist you and your staff with providing services to our members. If you have questions about the provider manual, please contact us at 202-467-2737.
- HSCSN Provider Manual [PDF - 7.85 MB]
Find other primary care and specialty providers within the HSCSN network or download the Provider Directory:
- HSCSN Provider Directory - English [PDF - 2.59 MB]
- HSCSN Provider Directory - Spanish [PDF - 2.67 MB]
Primary Care Providers
- 2016 HSCSN Provider Forum Invitation [PDF - 325 KB]
- No Shots, No School [PDF - 1.79 MB]
Learn more about the campaign to encourage required physical exams and vaccinations for students before the start of the 2016-2017 school year.
- Referrals and Authorizations of Services [PDF - 58 KB]
Authorization requirements for referrals to in-network and out-of-network medically necessary services.
- Transitioning of HSCSN Members [PDF - 281 KB]
- UM Authorization and Appeal Process [PDF - 41 KB]
Authorization process for services requiring prior authorization and the appeal process for denials.
How to Obtain Copies of Clinical Criteria, Benefit Provision, Guideline, Protocol or Other Similar Criterion on Which the Denial Decision is Based.
A copy of the clinical criteria, benefit provision, guideline, protocol or other similar criterion on which the denial decision is based will be provided upon your request.
You may obtain a copy of the portion of the InterQual ® Level of Care Criteria -Home Care that was considered in making this decision by sending a request to us at:
Utilization Management Department - Criteria Request
1101 Vermont Avenue N.W., 12th Floor
Washington, DC 20005
You may see the entire set of InterQual ® Level of Care Criteria -Home Care at the offices of a law firm, Terris, Pravlik & Millian, LLP, which is located at 1121 12th Street, N.W., Washington, D.C. 20005. They can be contacted via telephone at 202-682-2100. The Terris, Pravlik & Millian firm is available to advise you about the InterQual ® Level of Care Criteria -Home Care.
Applied Behavior Analysis
- Applied Behavior Analysis (ABA) Evaluation [PDF - 104 KB]
ABA services are available to HSCSN members with an established autism spectrum disorder.
- Provider Request Form for ABA Evaluation [PDF - 681 KB]
Request form for a request for an ABA evaluation.
- UM Medical Necessity Documentation Form for ABA Services [PDF - 637 KB]
Documentation form for a request for ABA services.
- Dental Procedures and Billing Requirements [PDF - 3.06 MB]
- Medicaid Pharmacy Providers: Antiretroviral Carve Out
Notice about expanded access to HIV antiretroviral medications through DC Medicaid Fee for Service pharmacy providers.
- HIV Services in the District of Columbia
Services ranging from HIV testing locations to medical care, medications and support services, including nutrition services and housing.
- Blood Lead Screening Requirements, 2015 [PDF - 144 KB]
Requirements for all Medicaid-enrolled children for lead exposure screening.
- DHCF DDOE lead screening letter 11-12 [PDF - 361 KB]
A review of the laws requiring lead screening during well-child visits for all children by the age of 24 months.
- HSCSN Lead Letter [PDF - 874 KB]
A reminder that all Medicaid eligible children must receive two blood lead screenings by 24 months of age.
- OB Provider Letter [PDF - 126 KB]
A letter announcing the District of Columbia Department of Health's new Obstetrical Authorization and Initial Assessment form.
- DHCF Obstetrical Authorization and Initial Assessment Form [PDF - 329 KB]
OB providers should make sure the new required Obstetrical Authorization and Initial Assessment form is completed during the first prenatal visit.
- DHCF OB Authorization Form Information [PDF - 734 KB]
A presentation about the changes made to the new Obstetrical Authorization and Initial Assessment form.
- DHCF Notice: IMM Clinic Closing [PDF - 164 KB]
Please be advised that the District of Columbia Department of Health's Immunization Clinic is closing down permanently.
- 2015-2016 VFC Influenza Order Form [PDF - 757 KB]
The District of Columbia Department of Health's order form for pediatric influenza vaccines.
- IMM: Newly Licensed Vaccines Availability [PDF - 359 KB]
Update recommendations and availability of human papillomavirus and meningococcal vaccines.
- Vaccines for Children Program [PDF - 51 KB]
A reminder that the non-compliant immunization list will be posted to the MOVEIT site monthly.
- VFC Provider Registration [PDF - 998 KB]
Providers participating in the Vaccines for Children Program should register using the provider agreement form.
Mental and Behavioral Health Providers
- Mental Health Provider Update, 2015 [PDF - 1.5 MB]
Two updates regarding the authorization process and documentation requirements for mental health services.
- HSCSN Mental Health Providers, 2013 [PDF - 66 KB]
An update noting HSCSN is no longer requiring authorization for mental health services by an in-network provider.
- Notification of Neuropsychological and Psychological Testing, 2012 [PDF - 82 KB]
Notice of a request form for neuropsychological testing.
- Home-Based Behavioral Health Services & Referral Form [PDF - 377 KB]