Medicaid Modernization

Click here to view the Iowa Health Link Public Comment Meeting Schedule.

Key Provider Implementation Resources ReleasedThe Iowa Department of Human Services announces the approval and release of key provider resources for the upcoming transition to managed care and launch of the IA Health Link program.

Several of the items approved and released include:
1. Managed Care Organization Provider Agreement Templates
2. Managed Care Organization Provider Manuals
3. Provider Universal Application
4. Provider Rate Baseline and Fee Schedule
5. Provider Network Fact Sheet

Managed Care Organization Provider Agreement Templates: DHS has approved the template agreements to be signed and executed between health care providers and the managed care organizations (MCOs). Each MCO has a separate agreement, and providers should contact the MCO directly to discuss the contracting process. Agreement templates can be accessed through each of the MCOs and you can find contact information listed below.

Managed Care Organization Provider Manuals: The manuals created by the MCOs for providers have been approved by the Department. Samples of the manuals can be found on the DHS website:
· Amerigroup Iowa, Inc. - https://dhs.iowa.gov/sites/default/files/Amerigroup_Provider_Manual_10272015.pdf
· AmeriHealth Caritas Iowa, Inc. - https://dhs.iowa.gov/sites/default/files/AmeriHealthCaritas_Provider_Manual_10272015.pdf
· UnitedHealthcare Plan of the River Valley, Inc. - https://dhs.iowa.gov/sites/default/files/UnitedHealthcare_Provider_Manual_10272015.pdf


DHS Universal Provider Credentialing Form: Iowa Medicaid has approved a streamlined application form that can be used for all four MCOs and captures all data points necessary for both Iowa Medicaid and the MCOs. The Iowa Medicaid Universal Provider Enrollment Application, 470-0254, and the Iowa Medicaid HCBS Waiver Provider Application, 470-2917, have been modified and providers will complete the universal application form and submit to Iowa Medicaid. With these modifications, providers are able to submit the same application to Iowa Medicaid as well as the MCOs, therefore streamlining the enrollment process. Iowa Medicaid will confirm provider enrollment to the MCOs through the provider master file and upon request. Providers accessing Council for Affordable Quality Health Care (CAQH) today may continue to do so for MCO credentialing. Providers must indicate on their CAQH account that they wish to share information with the MCO for credentialing. Access the Iowa Medicaid application form here [https://dhs.iowa.gov/sites/default/files/470-0254_5.pdf] and the Home and Community-Based Services application here [https://dhs.iowa.gov/sites/default/files/470-2917_7.pdf].

Provider Rate Baseline and Fee Schedule: DHS has established a reimbursement rate floor for most provider types. MCOs must extend offers to providers at the defined provider rate floor. Plans and providers can mutually agree to reimbursement or a structure other than the floor. In creating a rate floor DHS considered how best to provide stability for members and providers, yet enable the MCO’s to manage their provider networks. Other factors included:

  • Impact on MCO capitation rates which were based on historical Medicaid paid claims data and adjustments.
  • How the numerous current Medicaid reimbursement methodologies work today and will work in the future with the move to a comprehensive managed care environment.
  • MCO network adequacy requirements across geographical and service types.

You can find the rate floor information in Informational Letter 1562 [https://dhs.iowa.gov/sites/default/files/1562_ManagedCareOrganizationProviderReimbursementRateFloors.pdf].

Provider Network Fact Sheet: For more information on provider credentialing and contracting, please see the IA Health Link Provider Network Fact Sheet. This fact sheet has a number of details about claims processing and how the IA Health Link impacts different Medicaid populations and providers. Access the fact sheet here [https://dhs.iowa.gov/sites/default/files/IAHealthLink_ProviderNetwork_Factsheet_Final.pdf].

MCO Provider Contact Information

Amerigroup Iowa, Inc.
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
Phone: 1-855-789-7989

AmeriHealth Caritas Iowa, Inc.
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
Phone: 1-855-287-7855

UnitedHealthcare Plan of the River Valley, Inc.
New Providers: This email address is being protected from spambots. You need JavaScript enabled to view it.
Existing Providers: Contact your current contract manager

Additional questions can be directed to Iowa Medicaid Provider Services at 1-800-338-7909 (7:30 a.m. – 4:30 p.m., Monday- Friday) or at This email address is being protected from spambots. You need JavaScript enabled to view it..

Member Meeting Schedule Reminder: Iowa Medicaid is hosting meetings for Medicaid members to learn more about the IA Health Link program. These meetings will provide the public with an opportunity to receive information about the transition, ask questions directly to DHS staff, and receive in-person enrollment assistance. New meetings are being added weekly, please check the updated schedule to help members in your area find a meeting. Members may also access details on the meeting locations by calling Iowa Medicaid Member Services at 1-800-338-8366 (8:00 a.m. – 5:00 p.m., Monday- Friday) http://dhs.iowa.gov/sites/default/files/MemberEducation_and_EnrollmentEventsFlyer.pdf

Information on Medicaid Modernization can be found on the dedicated web page at: http://dhs.iowa.gov/ime/about/initiatives/MedicaidModernization.

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CMS Letter to Iowa - 12.7.15 Final

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MCO Provider Contract Reviews

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