A Service Entity is the parent organization. An Approved Service Entity Agreement is required before any facilities can enroll. Complete only the agreements for the cancer services (breast/cervical, colorectal, lung) your organization offers. Service Entity agreements must be digitally filled out; handwritten agreements are not accepted.If the Service Entity has more than one Tax ID, submit multiple agreements. Complete Service Entity Agreements only for the specific cancer services offered at Service Entity facilities.
Send completed Service Entity Agreement and W-9 to [email protected]
Iowa HHS will return the fully executed agreement for your records. The date Iowa HHS signs your Service Entity Agreement marks the start of your six-year enrollment period.
A Facility is the location the services will occur. Apply for a Facility after the parent Service Entity is approved. Submit one Facility Application per facility address. If there are multiple facilities, multiple applications are required. Complete applications only for the specific cancer services done at that location.
To enroll a Facility:
Complete the Facility Application per facility address.
A CLIA certificate is required for in-office lab tests:
Breast and Cervical: Pap cytology, HPV, breast biopsy, waived tests
Colorectal: FIT/FOBT (non‑automated), Pathology on colorectal biopsies
Lung: Cytology on lung specimens
A CLIA certificate is not required for:
Breast and Cervical: mammograms, breast ultrasounds or breast MRI
Colorectal: Colonoscopy procedures when no in‑office lab testing is performed
Lung: Low‑dose CT
Iowa HHS will process your request and email you when the facility is approved. Facility approval remains in effect until the expiration date of your Service Entity Agreement.
Electronic claims submissions are to be submitted electronically. MBS accepts 1500 claim forms electronically, but not UB claim forms. Provider clearing houses are to be provided with the following information:
Program participants must not be billed for any covered cancer screening service.
Providers must inform participants before services are provided which services are covered by the program and which are not.
Iowa HHS cancer screening programs serve as the payor of last resort, meaning all other payment sources must be used first when they exist.
Federal law requires that reimbursement using federal funds may not exceed Iowa Medicare Part B rates. Iowa HHS reimburses approved healthcare providers for covered services at Iowa Medicare Part B rates, which are updated annually after CMS releases new rates.
Providers must accept Iowa HHS reimbursement as payment in full for covered services.
Providers may not bill participants or Iowa HHS for:
Covered program services
Claims denied due to late filing
Specimen collection or transportation, as these costs are included in the office visit reimbursement
When a participant has insurance (Breast & Cervical Program only), providers must submit claims to the insurer first and provide an Explanation of Benefits (EOB) before submitting to Iowa HHS.
Providers must submit participant screening and diagnostic results to the local Iowa HHS cancer program within 10 business days of the date of service. Results should be submitted prior to claim submission.
List items for Breast and Cervical cancer - FAQs for reimbursement
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.
What is a “local program” and what is their role?
A “local program” is a local public health agency that contracts or subcontracts with Iowa HHS to assist in the enrollment and navigation of Iowa HHS Cancer Program Participants.
What is a “participant”?
A “participant” is an individual who is enrolled in an Iowa HHS Cancer Program. To be a participant, the individual must enroll yearly through a local program. Participant are considered active for 1 year of enrollment. Participants must be active to have services paid for by Iowa HHS Cancer Programs.
What is the role of Iowa HHS?
Iowa HHS oversees the administration of Iowa HHS Cancer Programs. This includes providing funding and guidance to local programs, and ensuring that enrolled participants receive approved services. Iowa HHS also maintains program guidance and policies, monitors performance, and supports local programs in delivering consistent and effective services statewide.
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.
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.
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.
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)
What reimbursement rates does Iowa HHS use?
Federal law requires that reimbursement using federal funds may not exceed Iowa Medicare Part B rates. Iowa HHS reimburses approved providers for covered services at these rates, which are updated annually following CMS rate releases.
How do I resubmit a denied claim?
If a previously denied claim is being resubmitted, the provider must clearly label it as a Corrected Claim at the top of the form. Claims not labeled as corrected will be denied as duplicates.
Does Iowa HHS provide reporting on claim payments?
Yes. Iowa HHS provides contracted programs with a Claims Reimbursement Report that includes: participant name, date of birth, date of service, provider name, CPT/ICD-10 codes billed, allowed amount, paid amount, and any denial explanations
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.
What is the responsibility of being a Service Entity?
The Service Entity's responsibilities are written in the Service Entity Agreement.
What is the responsibility of being a Facility?
A Facility is responsible for providing clinical services to Iowa HHS Cancer Program participants in accordance with program policies and reimbursement requirements. Facilities must deliver services that meet program standards, submit accurate and timely billing, and coordinate with Local Programs and Iowa HHS to ensure facilities maintain active enrollment and participants receive appropriate, approved care.
How quickly must providers submit results to the local program?
Providers must submit participant screening and diagnostic results to the local Iowa HHS cancer program within 10 business days of the date of service.
Results should be submitted prior to claim submission to ensure appropriate navigation, follow‑up, and payment processing.
What if a provider does not know which local program the participant is enrolled in?
If you are unsure which local program the participant came from, send a secure email to [email protected]
Include the following information:
Participant First Name
Last Name
Date of Birth (DOB)
Iowa HHS will identify the correct local program and provide further direction.
Is there a form providers must use to send results back to the local program?
Yes. A standardized form is available for providers to submit results to the participant’s local program. You may obtain this form by contacting:
Must a participant be actively enrolled on the date of service?
Yes. Participants must have an active enrollment with a local Iowa HHS cancer program on the date of service.
Services cannot occur before enrollment.
Enrollment is completed at the local program level, and providers should verify enrollment status prior to delivering any program‑covered services.
Are there any reporting requirements to be an Iowa HHS approved Service Entity or Facility?
No. There are no additional reporting requirements to maintain status as an Iowa HHS–approved Service Entity or Facility beyond ensuring that each participant has an active enrollment at the date of service.
Local programs handle participant enrollment, and providers must verify enrollment before delivering any program‑covered services.
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?
