Cancer Provider Services

What is the difference in a Service Entity and a Facility?

• A Service Entity is the parent organization. A Facility is the location the services will occur.

Can a Service Entity be a Facility?

• Yes. If the Service Entity address also provides screening or diagnostic services, it is also a Facility. Submit a Facility Application for that address. Example: Oxford Hospital is the Service Entity and also provides breast and cervical screening and diagnosis. Oxford Hospital must also be an approved Facility.

Can we use one Service Entity Agreement for multiple Tax IDs?

• No. Complete a separate Service Entity Agreement for each Tax ID.

Who should sign the Service Entity Agreement?

• An authorized signer for the parent organization should sign. An administrative or billing representative should be the main contact listed.

Do we need to submit all three of the Service Agreements (breast/cervical, colorectal and lung)?

• Submit a Service Entity Agreement only for the programs your organization offers. If you offer services for all listed cancers, submit all three agreements. If you offer only services for some listed cancers, submit agreements only for those. Complete a separate agreement for each Tax ID.

Do we need to submit all three of the Facility Applications (breast/cervical, colorectal and lung)?

• Submit Facility Applications only for the specific cancer services provided at that location. Submit an application per address per cancer type. For example, if a site provides breast and cervical and colorectal services, submit two applications. If the site provides breast and cervical, colorectal, and lung services, submit three applications.

Do we need a Facility Application for each address?

• Yes. Submit one Facility Application for each physical location where services are provided.

Who should fill out the facility application?

• A contact at the facility who manages or oversees daily operations and can answer questions related to facility providers.

Can we list individual provider NPIs on the Facility Application?

• Use the Group NPI for the site when possible. If a Group NPI is not available, list the clinic’s primary NPI.

What if our Service Entity changes its Tax ID or legal name?

• Email [email protected] with the change. You may need to submit a new Service Entity Agreement and updated W‑9.

Can a Facility apply before the Service Entity is approved?

• No. The Service Entity must have an active, signed agreement before any Facility can apply.

When does the Service Entity Agreement expire?

• Six years after the date Iowa HHS signs the agreement, unless ended sooner by either party.

When does the Facility approval expire?

• The Facility approval ends on the same date as the Service Entity agreement. This is six years after the date Iowa HHS signs the Service Entity agreement, unless ended sooner by either party.

Do all of the facilities of the Service Entity need to apply to become Approved Facilities?

• Only facilities that provide breast, cervical, lung, or colorectal screening or diagnostic services need to apply.

If a facility provides more than one type of cancer service, do we need to fill out multiple facility applications?

• Yes. Submit a Facility Application for each program offered at that site. For example, if the site provides breast and cervical, colorectal, and lung services, submit three applications. If the site provides cervical and colorectal services only, submit two applications: Breast and Cervical, and Colorectal.

What if a Facility moves to a new address?

• Submit a new Facility Application for the new address. Notify Iowa HHS when the old site closes.

What if a Facility adds or stops offering a cancer service?

• Email [email protected]. You may need to submit or update Facility Applications for the programs offered at that location.

If a lab is at the same physical address as the clinic but uses a different Tax ID and NPI, does it need its own enrollment?

• Yes. The lab needs its own Service Entity Agreement for its Tax ID and its own Facility Application for that address. Claims must use the lab’s enrolled Tax ID and the Approved Facility address and NPI.

Do we need a separate Service Entity Agreement for the lab if it is part of the Facility, but has a different TIN?

• Yes. The lab must submit a Service Entity Agreement, once approved, the lab must submit a Facility Application.

Do we need a separate Facility Application for the lab if it is part of the Facility, has the same TIN but has its own NPI?

• Yes. Submit a Facility Application for each site that provides services. If the lab is a distinct billing entity at that address, submit a separate application for the lab.

If we collect a specimen for a lab test but send it to an outside lab, do we need to submit our CLIA certificate?

• No. If your facility only collects and ships the specimen and does not perform any laboratory testing, your facility is not acting as a laboratory under CLIA and does not need to submit a CLIA certificate.

What if the CLIA certificate for a facility expires or changes?

• Send updated certificates whenever they expire or change to [email protected].

Is a CLIA certificate always required?

• No. CLIA applies to lab tests on human specimens. It does not apply to imaging (mammography, ultrasound, MRI, CT)

Where can I find information about reimbursement?

• Find more information here:  Breast & Cervical Cancer - Claims Processing and Reimbursement 

What items must be included with claims to ensure smooth processing?

• The Service Entity Tax ID must match an Approved Service Entity Agreement that is active on the date of service. The Facility address on the claim must match an Approved Facility address that is active on the date of service. The Facility NPI used on the claim must match the Approved Facility’s enrollment. The participant must be enrolled in the program at the time of service.

Can facilities or providers enroll participants?

• No, participants must enroll through local programs. For a connection to the local program in your area, email [email protected].

Who can I contact in the future about Iowa HHS Cancer Programs?

The email [email protected] is monitored by Iowa HHS staff.