Provider-Specific Resources

Provider Applications

Iowa Medicaid Universal Provider Enrollment Application (August 2023)

Iowa Medicaid Universal Home- and Community-Based Services Waiver Provider Application (February 2023)

Provider Enrollment

The Iowa Medicaid Enterprise (IME) has developed a visual aid to help prospective providers better understand the process for enrolling with IME. This only describes the IME enrollment process. Once a provider is enrolled with the IME, they must go through the Managed Care Organization (MCO) credentialing process. Download and print the Provider Enrollment Process Flow Chart.

Managed Care (MC) Covered Benefits

The Iowa Medicaid Enterprise (IME) has developed a comparison document which provides information on basic required benefits for Medicaid, Iowa Health and Wellness Plan, and Hawki. View the Comparison Grid here.

Prior Authorization (PA) Summary by Plan

The Iowa Medicaid Enterprise (IME) has put together a prior authorization (PA) summary by plan. Quickly view and compare PA requirements for each plan with this easy-to-use chart. Download and print the PA requirements by plan. (May 2019)

Vision Benefit Guide

The Iowa Medicaid Enterprise (IME) has put together a vision benefit summary by plan for the IA Health Link managed care program. Providers can quickly view key contact information and requirements for each plan and each coverage group with this easy-to-use chart. View the vision benefit guide. (September 2021)

Work Process Flow Charts for Various Medicaid Programs

Iowa Medicaid provides health coverage to more than 700,000 Iowans through a variety of different programs. These programs have processes in place to make sure members get the care they need. Some processes are complex, but important to understand. The Iowa Medicaid Enterprise (IME) has developed visual aids to help members, providers and stakeholders better understand the various processes in place at the IME.

Translation and Interpretation Services

Medicaid is federally obligated to provide translation services. Translation services are available to IA Health Link members—through their Managed Care Organization (MCO)—and are also available for Iowa Medicaid Fee-for-Service (FFS) members.

Member Choice

Guidelines for Providers

Medicaid Tools for Providers

Electronic Visit Verification Resource Center (EVV)

EVV will be used to monitor the delivery and utilization of personal care and home health services in non-traditional settings and will provide verification of the visit with location information and a time stamp. EVV will be used to ensure quality and program integrity (PI) and is a valuable mechanism to ensure that members are receiving the care they need that is outlined in their service plan. This system will help provide real time alerts when a provider is late or misses a medically necessary service included in a member’s service plan.

Medicaid Presumptive Eligibility Portal (MPEP)
The Medicaid Presumptive Eligibility Portal (MPEP) is a self-service portal that is used by an approved qualified entity (QE) for presumptive Medicaid eligibility determinations. More information regarding presumptive eligibility (PE) can be found on the presumptive eligibility webpage.

Electronic Data Interchange Support Services (EDISS)
The Iowa Medicaid Enterprise (IME) is contracted with an electronic vendor, Electronic Data Interchange Support Services (EDISS). This company provides free software for providers to electronically file claims, PC- ACE pro 32, as well as a web-based application "EDISS Connect". The above link explains how TOB allows providers:

to access Electronic Remittance Advice (835)
to manage their paper work
to access real time updates to the electronic system

A wide range of education regarding TOB along with electronic billing is also available on www.edissweb.com.

Eligibility and Verification Information System (ELVS)
Read more about the ELVS web portal and the procedure for logging in for providers 24/7 which can be used to pick up and drop off batch files and submit real-time requests for Eligibility, Claim Status, Prior Authorizations and Provider Summary.

Iowa Medicaid Electronic Records System (IMERS)
Iowa Medicaid Electronic Records System (I-MERS) is a web-based tool that is free-of-charge that allows treating providers electronic access to up-to-date information about all claims submitted to Iowa Medicaid Enterprise (IME) for all current eligible Medicaid members. I-MERS does not include sensitive information on mental health, HIV/AIDS and other information excluded by the state. It is used by treating providers to access critical claim information for medical procedures, prescriptions, and other medical care that eligible Medicaid members have received. I-MERS also assists providers in caring for members, coordinating their care, reducing costly duplicated services and assisting in maintaining high quality care for Medicaid members.

Iowa Medicaid Portal Access (IMPA)
The Iowa Medicaid Enterprise (IME) implemented a provider portal called Iowa Medicaid Portal Access (IMPA) that is managed by the Provider Services unit. IMPA is a web-based tool that allows providers access to multiple different functions that may be needed. Through this tool providers are able to access: