Provider Outcomes

Iowa Medicaid's Mission

Iowa Medicaid is committed to ensuring that - all members have equitable access to high quality services that promote dignity, barriers are removed to increase health engagement, and whole person health is improved across populations.  

In pursuit of our mission, Iowa Medicaid is launching an initiative to increase the quantity, quality, and breadth of active providers in good standing with Medicaid to deliver the necessary services to our members.

Proposed Outcomes

Improve the Provider Enrollment Process with Iowa Medicaid/IME

Desired Outcome: Decrease the time required to enroll with Iowa Medicaid to provide services.

Success Criteria 

• Providers report the enrollment process with Iowa Medicaid is easier.

• The average elapsed time to complete the enrollment process is reduced.

Improve the Provider Credentialing Process with the MCOs/Dental Plans 

Desired Outcome: Decrease the time required to credential with MCOs/dental plans.

Success Criteria 

• Providers report the credentialing process is easier. 

• The average elapsed time to complete the credentialing process is reduced 

Improve the Provider Re-enrollment Process 

Desired Outcome: Decrease the effort and elapsed time required for a provider to remain active in good standing to provide Medicaid services. 

Success Criteria 

• Providers report it is easier to maintain their active enrollment status to provide services to Medicaid members. 

• The average elapsed time to complete the re-enrollment and re-credentialing processes are reduced. 

Improve Provider Rates Based on a Market Analysis 

Desired Outcome: Improve rates based on a comparison to other payers / Medicaid programs to ensure equity in rates for services. 

Success Criteria 

• The variance in rates paid by Medicaid for the same services in the same locations is reduced.

• The rates paid by Medicaid for the same services in the same locations are improved on a percentage comparison basis to other payer rates. 

Improve the Provider Understanding of Key Information

Desired Outcome: Improve the provider understanding of key provider responsibilities, operational information, and program policies.

Success Criteria 

• Provider questions to Iowa Medicaid are less.

• Fewer errors are caused by inaccurate understanding of information.

• Less time required of support staff to respond to provider questions.

• The number of providers on pre-payment reviews is reduced.

• The number of denied claims is reduced.

Improve Provider Quality, Integrity, and Compliance 

Desired Outcome: Reduce the overall risk level of active providers providing services to Medicaid members.

Success Criteria 

• More providers are in good standing with Iowa Medicaid.

Improve Provider Claims Processing 

Desired Outcome: Reduce the effort required and elapsed time to process claims (from submission to payment receipt).

Success Criteria 

• Providers report it is easier to successfully complete claims processing process (including prior authorization steps and denial/appeals).

• Elapsed time from claim submission to payment decreases (including denied/appealed claims).

Improve Provider Network Adequacy to Meet Medicaid Service Needs 

Desired Outcome: Increase Medicaid provider participation to meet the needs of Medicaid members.

Success Criteria 

• Gaps in care are reduced by geographic location, service type, and payer.

• Medicaid members have greater access to the services they require (includes both availability of services and transportation to the services) 

• Fewer Medicaid members waiting for needed services.

• Medicaid members spend less time waiting for services.

• The average distance for needed services decreases.

• Fewer emergency room visits and ambulance trips.