How to become a Medicaid provider in District of Columbia
To bill District of Columbia Medicaid, enroll through DC Medicaid Provider Data Management System (PDMS), run by Gainwell Technologies. The process has 5 steps, listed below with the documents the state asks for.
- Enrollment portal
- DC Medicaid Provider Data Management System (PDMS)
- Steps
- 5
- Documents
- —
- Plans listed
- 3
On this page
District of Columbia Medicaid enrollment at a glance
To bill District of Columbia Medicaid, enroll through DC Medicaid Provider Data Management System (PDMS), run by Gainwell Technologies. The process has 5 steps, listed below with the documents the state asks for.
- Program
- DC Medicaid (Department of Health Care Finance)
- Enrollment portal
- DC Medicaid Provider Data Management System (PDMS)
- Fiscal agent
- Gainwell Technologies (fiscal agent and claims vendor since March 2, 2026, replacing Conduent)
- Application fee
- DHCF has collected the institutional application fee at enrollment and re-enrollment since May 1, 2015, under the District's Medicaid provider screening, enrollment and termination rule. Federal rule (42 CFR 455.460): the state must collect the CMS application fee from institutional providers that are newly enrolling or re-enrolling; individual physicians and non-physician practitioners are exempt, as are providers already enrolled in (or that already paid the fee to) Medicare or another state's Medicaid/CHIP. CMS set the fee at $750 for calendar year 2026.
- Fingerprinting
- Federal rule (42 CFR 455.434, 455.450(c)): providers the state places in the 'high' categorical risk level, and anyone owning 5% or more of such a provider, must submit fingerprints for a criminal background check.
- Site visit
- Federal rule (42 CFR 455.432, 455.450(b)-(c)): the state must do site visits before and after enrollment for providers in the 'moderate' or 'high' risk levels, and any enrolled provider must allow unannounced on-site inspections.
- Revalidation
- Federal rule (42 CFR 455.414): every enrolled provider must be revalidated at least once every 5 years.
- Provider manual
- Provider manual
Steps
- Enroll or re-enroll through the DC Medicaid Provider Data Management System (PDMS)
- Pay the application fee if an institutional provider (unless exempt)
- Complete risk-based screening (site visit and/or fingerprinting if moderate/high risk)
- Register on the Gainwell-run DC Medicaid provider portal to bill (required since the March 2026 transition)
- To serve DC Healthy Families or CASSIP members, contract with and be credentialed by the managed care plan(s)
Joining managed-care plan networks
- Credentialing
- Most DC Medicaid beneficiaries under 21 are in risk-based managed care. Each managed care plan maintains and credentials its own provider network, so providers contract with each plan separately after DC Medicaid enrollment. DHCF describes no centralized credentialing. Centralized credentialing: no. On August 1, 2026, Wellpoint DC members were moved to AmeriHealth Caritas DC.
- Plans (state list)
- AmeriHealth Caritas DC
- MedStar Family Choice DC
- Health Services for Children with Special Needs (HSCSN) — CASSIP
Frequently asked questions
How do I become a Medicaid provider in District of Columbia?
To bill District of Columbia Medicaid, enroll through DC Medicaid Provider Data Management System (PDMS), run by Gainwell Technologies. The process has 5 steps, listed below with the documents the state asks for.
Is there an application fee to enroll in District of Columbia Medicaid?
DHCF has collected the institutional application fee at enrollment and re-enrollment since May 1, 2015, under the District's Medicaid provider screening, enrollment and termination rule. Federal rule (42 CFR 455.460): the state must collect the CMS application fee from institutional providers that are newly enrolling or re-enrolling; individual physicians and non-physician practitioners are exempt, as are providers already enrolled in (or that already paid the fee to) Medicare or another state's Medicaid/CHIP. CMS set the fee at $750 for calendar year 2026.
How often must District of Columbia Medicaid providers revalidate?
Federal rule (42 CFR 455.414): every enrolled provider must be revalidated at least once every 5 years.