Medical Billing Services in Washington, DC
Billing, coding, credentialing and denial management for Washington, DC practices, with Medicare claims through Novitas Solutions (Jurisdiction JL) and Washington, DC Medicaid handled by people who know the rules.
Medical billing for Washington, DC practices
Washington, DC has one of the highest rates of health coverage in the country, and its Medicaid program went through major changes in 2026. The Department of Health Care Finance moved its fiscal agent from Conduent to Gainwell Technologies on March 2, 2026, and Wellpoint DC left the managed care program on July 31, 2026, with its members reassigned to AmeriHealth Caritas DC. Medicare Part B is processed by Novitas Solutions in Jurisdiction L.
Commercial coverage is led by CareFirst BlueCross BlueShield, and many patients have federal employee plans or Maryland and Virginia coverage. SFA Solutions works with practices across the District remotely. We work inside your existing EHR, submit most clean claims within 24 hours and keep up with DC Medicaid plan and portal changes.
Washington, DC at a glance
| Medicare contractor | Novitas Solutions, Jurisdiction JL |
|---|---|
| Medicaid timely filing | 365 days from the date of service for fee-for-service claims; managed care plans set their own limits |
| NP practice authority | Full |
| Cities we serve | Washington, Capitol Hill, Georgetown, Navy Yard, Anacostia, Columbia Heights, Foggy Bottom |
What Washington, DC billing involves
These are the programs and rules our team works with for Washington, DC claims.
Medicare
Novitas Solutions · JLWashington, DC Part B claims are processed by Novitas Solutions in Jurisdiction JL. Medicare's filing limit is 12 months from the date of service, and appeals start with a redetermination within 120 days of the initial decision.
Washington, DC Medicaid
DC Medicaid (Department of Health Care Finance), including the DC Healthy Families Program; the locally funded DC Healthcare Alliance
Portal: DC Medicaid provider portal at medicaid.dc.gov, operated by the fiscal agent Gainwell Technologies since March 2, 2026
Medicaid managed care
Most members are enrolled in AmeriHealth Caritas DC or MedStar Family Choice DC. Health Services for Children with Special Needs (HSCSN) serves children in the CASSIP program, and Wellpoint DC members were moved to AmeriHealth Caritas DC on August 1, 2026.
Timely filing
365 days from the date of service for fee-for-service claims; managed care plans set their own limits.
Commercial and Medicare Advantage
CareFirst BlueCross BlueShield is the largest commercial payer, followed by Aetna, UnitedHealthcare, Cigna and Kaiser Permanente of the Mid-Atlantic States. Federal Employees Health Benefits plans are common.
Prompt pay law
D.C. Code 31-3132 requires health insurers to pay clean claims within 30 days of receipt. Interest starts on day 31 at 1.5% per month, rising to 2% after 60 days and 2.5% after 120 days.
Nurse practitioners
Full practiceDC nurse practitioners can practice and prescribe without physician collaboration. NPs can enroll as independent rendering providers with Medicare, DC Medicaid and commercial plans.
Credentialing
Providers had to register with the new Gainwell portal before March 2, 2026 to keep submitting DC Medicaid claims, and each managed care plan credentials separately. CareFirst and the national carriers use CAQH ProView. Medicare enrollment goes through PECOS with Novitas JL.
Billing challenges Washington, DC practices face
2026 plan transition
Wellpoint DC stopped covering members after July 31, 2026, and those members were auto-assigned to AmeriHealth Caritas DC on August 1. Claims for later dates of service sent to Wellpoint will deny. Re-verifying each DC Medicaid patient's plan before the visit helps prevent that.
New fiscal agent system
DHCF moved fee-for-service claims processing from Conduent to Gainwell in March 2026. Practices had to register on the new portal, and payer IDs, remittance formats and enrollment records may need updating. Reviewing your clearinghouse and portal setup avoids rejected claims.
Multistate patients
Many DC patients live or work in Maryland or Virginia and carry coverage from those states. Out-of-state Medicaid and some commercial products require separate enrollment or network participation. Identifying the true payer at intake keeps these claims from stalling.
Our services in Washington, DC
Medical Billing
Learn moreCredentialing & Payer Enrollment
Learn moreMedical Coding
Learn moreDenial Management
Learn moreA/R Recovery
Learn moreEligibility Verification & Prior Authorization
Learn moreMedical Billing Audit
Learn moreRevenue Cycle Management
Learn moreSpecialties we bill in Washington, DC
Washington, DC medical billing questions
What is the timely filing limit for DC Medicaid?
DC Medicaid fee-for-service claims must be submitted within 365 days from the date of service. Managed care plans such as AmeriHealth Caritas DC and MedStar Family Choice DC set their own limits in provider contracts.
What changed with DC Medicaid in 2026?
DHCF moved its fiscal agent from Conduent to Gainwell Technologies on March 2, 2026, with a new provider portal at medicaid.dc.gov. Wellpoint DC also left the managed care program on July 31, 2026, and its members were reassigned to AmeriHealth Caritas DC.
How fast must DC insurers pay clean claims?
Under D.C. Code 31-3132, health insurers must pay clean claims within 30 days. Interest is owed from day 31 at 1.5% per month, increasing to 2% after 60 days and 2.5% after 120 days.
Who is the Medicare contractor for Washington, DC?
Novitas Solutions processes Medicare Part B claims for DC under Jurisdiction L, which also covers Delaware, Maryland, New Jersey and Pennsylvania.
Get a free billing audit for your Washington, DC practice
We will review your recent claims and denials against Washington, DC payer rules and show you what can be recovered.
Nearby states
Primary sources
- DHCF Medicaid Director Letter 26-01: fiscal agent transition
- DHCF Transmittal 26-19: managed care plan transition
- DHCF Medicaid managed care organizations
- DHCF timely filing notice
- D.C. Code 31-3132
- CMS: A/B MAC Jurisdiction L (Novitas Solutions)
Payer rules change. Last reviewed against the primary sources above on . Confirm current rules with the payer before relying on them.
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