Iowa Medicaid's procurement office issues a Request for Proposal (RFP) to find organizations to handle different aspects of healthcare. RFPs require detailed answers in each request, outlined in the Bidders' Libraries.
Bidders' Libraries
Iowa Medicaid
- Iowa Medicaid
- Iowa Medicaid Organization Chart
- Iowa Health Link Program
- Managed Care Contracts
- Iowa Medicaid Dashboard
- Iowa Medicaid Strategic Plan
Member Communication
Member Demographics
Users can find detailed information on member demographics. The section allows users the ability to filter by date, plan coverage group, age, gender, race/ethnicity, county and any of these combinations.
Key financial metrics are found here, including net rates cells, Medical Loss Ratios (MLR), Third Party Liability (TPL), historical expenditures, market shares based on expenditures and financial information by county.
Bidder's Conference Presentation Documents
- IA Health Link - SFY26 Rate Development
- IA Health Link - SFY26 Rate Estimate Appendices
- Optumas_IA RFP Rate Estimate PPT
- MED-26-001 IA Health Link Bidder's Conference PPT
Provider
Policy
Programs
Long Term Services and Supports
- Facility
- HCBS
- HCBS Waivers
- HCBS Critical Incident Form
- MFP
- CCO
- HBCS Settings
- 1915i Habilitation Services
- Pharmacy - note that these links may be inactive due to Change Healthcare's nationwide outage. More information here.
- Informational Letters
- Pharmacy Reimbursement
- Pharmacy POS Informational Letters
State Plan Waivers
- State Plan
- 1915c
- Iowa Health and Wellness
- 1915b Wavier Narrative and 1915b Wavier Appendix
- 1915i
IA Health Link Performance Reports
Business Requirements Documents
Vendor Security Questionnaire (VSQ)
RFP MED-25-009: Pharmacy Benefit Administration for Claims Processing, Drug Rebate and Pharmacy Clinical Services (PBA Services)
Iowa Medicaid
Iowa Medicaid Organization Chart
Change Management Requests
RFP MED-25-009 CMRs (zip file)
Contracts and Amendments
RFP MED-25-009 Contract & Amendments (zip file)
Interfaces
FINAL_Attachment 72_Interface Register_ DW_03222022_active
Iowa Medicaid Member Population
Iowa Medicaid Member Population
Manuals
Iowa Medicaid Drug Rebate Program Policy and Procedures Manual
Prior Authorization Criteria
PA Criteria Chart Effective Jan 2024
Reports
RFP MED-25-009 Reports (zip file)
Current Contract Documents
MED-19-003 Executed Amendment 1
MED-19-003 Executed Amendment 2
MED-19-003A Executed Amendment 3
MED-19-003A Executed Amendment 5
MED-19-003A Int'l Business Machines Corp AMD4 Signed
Managed Care Plan Oversight Templates
Final Amendment F1 Iowa Financial MRT-TPL
MCP PI1-P17 Program Integrity Report
MCP PI8-PI10 Program Integrity Cumulative-Quarterly Update and Reporting
MCP PI11 Single Case Agreement Quarterly Report
MCP PI12 Program Integrity Annual Work Plan
MCP PI13 Program Integrity Compliance Plan
Program Integrity Reporting Companion Guide
Program Integrity Templates and Matrix
Monthly Program Integrity Reporting
PI1 Investigative Activities Report
Provider Alert List Templates
Standard Operating Procedures
Audits and Investigations
Full Review Investigative Process
Guidelines for Preparation and Management of Provider Appeal Related to FWA
Payment Error Rate Measurement (PERM) Process
Unified Program Integrity Contractor (UPIC) Investigation Collaboration
Data Analytics
Deceased Provider File Comparision
Identifying and Recouping Capitation Payments for Deceased Members
Identifying and Recouping Capitation Payments for HIPP Members
Identifying and Recouping Capitation Payments for Incarcerated Members
Financial
Complying with State Auditor Requests
Confirming PI Credit Balances for Revenue Collections
Deficit Reduction Act of 2005, Section 6032: Reviewing Provider Policies
Extrapolating Error Rate from Statistical Sampling to Larger Populations
Interest on Program Integrity Overpayments
Maintaining and Updating the Over 60-Day Report
Overpayment Findings, Revision, in AR Database to Original Findings
Overpayment, Claims Billed Using Deceased Provider Numbers
Overpayments, DIA and MFCU Recoveries
Preparing to Release or End Liens Against Provider Real Property
Receiving and Processing Iowa Department of Revenue Recovery Reports
Receiving and Processing Transfers of Overpayments from other Iowa Medicaid Units
Verification of Financial Data in Recoupment Spreadsheets
Verification of Month-End AR Data Uploaded to the Data Warehouse
Write-Off of Uncollectable Program Integrity Accounts Receivable
Managed Care Oversight
Performance Tracking and Dashboards
Preparing MCP Monthly Meetings
Provider Enrollment from MCP Provider Actions
Real Time Open Case Report Process
Review of Monthly MCP Report for Monthly Template Questions
Reviewing of Annual MCP Report
Reviewing of Monthly MCP Report
Review of Quarterly MCP Report
Sending a Good Cause Exception (GCE) Request
Updating the MFCU Referral Case Review Spreadsheet
Iowa Medicaid Resources
Iowa Medicaid Organization Chart
Managed Care Contracts and Prior Managed Care Procurements
Policy
Find additional information for RFP MED-25-002 Quality Improvement Organization for Iowa Medicaid below.
Iowa Medicaid
Iowa Medicaid Organization Charts
Quality Improvement Organization (QIO)
QIO Contract
MED-18-005: QIO Services Amendment 1
MED-18-005: QIO Services Amendment 2
MED-18-005: QIO Services Amendment 3
MED-18-005: QIO Services Amendment 4
MED-18-005: QIO Services Amendment 5
MED-18-005: QIO Services Contract
QIO Standard Operational Procedures
QIO A15 Service Plan Reduction
QIO HCBS New Provider Application
QIO HCBS Provider Self-Assessment
Report Examples
QIO Services Monthly Deliverables Report
QIO Services Monthly ETP Fiscal Impact Report
2018 RFP Proposals and Evaluation
KEPRO MED-18-015 Iowa QIO Services: Attachment F - Cost Proposal
KEPRO MED-18-015 Iowa QIO Services: Tab 4.1-4.2 Redacted 1
KEPRO MED-18-015 Iowa QIO Services: Tab 4.1-4.2 Redacted 2
KEPRO MED-18-015 Iowa QIO Services: Tab 4.3-4.4.8 Redacted 2
KEPRO MED-18-015 Iowa QIO Services: Tab 5 Redacted 2
MED-18-015 Iowa QIO Services: RFP Scoring Sheet
Telligen Iowa QIO Services: Attachment F Cost Proposal
Telligen Iowa QIO Services: Technical Proposal Public Copy Redacted
Iowa Medicaid
Iowa Medicaid Table of Organization Chart
Revenue Collections and Estate Recovery Contract
Operational Procedures
1. Accounts Receivable Procedure
3. Carrier Refund Request through Fiscal Management
4. Check Handling and Deposit Operational Procedure
8. Iowa Health and Wellness Plan (IHAWP) Premium Processing and Dental Premiums Procedure
11. Iowa Care Premium and Waiver Processing Procedure
12. Iowa Medicaid Trust Program Processing Procedure
15. Medical Assistance Income Trust (Miller Trust)
16. Obtaining Debt Information
18. Provider Withholding Procedure
19. Refund Manual Check Request
20. Returned Warrants Procedure
21. Revenue Collections MEPD Premium Processing Procedure
22. Review of Medical Assistance Debt Response Forms (MADRF)
24. Verification of Insurance Procedure
Report Examples
1. Template - IACI HMS REBILLS
2. Template - Maestro <Month/Year> Deposit Report
3. Template - OnBase <Month/Year> Deposit Report
Find additional information for RFP MED-24-004 Dental Wellness Plan (DWP) and Hawki request for proposal (RFP) below:
Iowa Medicaid
Iowa Medicaid Organization Chart
Member Demographics
Enrollment Report for State Fiscal Year (SFY) 2022
Enrollment Report for SFY 2022 by Month
Provider Communication
Dental Wellness Plan Fee Schedule, Coverage
Member Communication
Dental Wellness Plan Member Materials
Policy
Iowa Administrative Code Chapter 441
Dental Wellness Plan Provider Manual
State Plan Waivers
Iowa Health and Wellness (IHAWP)
Performance Reports
Medicaid Managed Care Quarterly Reports
Iowa Managed Care Reporting Manual*
Iowa Managed Care Reporting Manual Calendar*
*Note: These materials are currently being used in Iowa HealthLink. The final Dental Reporting Manual is expected to follow this model and function similarly.
Rates
Bidder's Conference
Date and Time:
Monday, June 5, 2023 2:00 PM to 3:30 PM
Location
Zoom link: https://www.zoomgov.com/j/1601365358
Meeting ID: 160 136 5358
Materials
Iowa Medicaid Presentation
Optumas Presentation
Security and Privacy Requirements
Business Requirements Documents
Social Determinants of Health: Oral Health Equity Risk Assessment Questions
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