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)
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 Comparison
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
About Iowa Medicaid (Medicaid Program Information)
Iowa Medicaid Organizational Chart
Iowa Medicaid Table of Organization
Previous Procurement Documents for Technical Assistance and Program Support for Iowa Medicaid
Previous RFP Documents
- Berry Dunn Cost Proposal
- Berry Dunn Technical Proposal
- Health Management Cost Proposal
- Health Management Technical Proposal
- Mercer Cost Proposal
- Mercer Technical Proposal
- Navigant Cost Proposal
- Navigant Technical Proposal
- Sellers Dorsey Cost Proposal
- Sellers Dorsey Technical Proposal
- RFP Scoring Sheet
Previous and Current Contract Documents
- MED-13-011 Contract – Executed
- MED-13-011 Amendment 1 - Executed
- MED-13-011 Contract Renewal - Executed
- MED-19-011 Contract – Executed
- MED-19-011 Amendment 1 – Executed
- MED-19-011 Amendment 2 – Executed
- MED-19-011 Amendment 3 – Executed
- MED-19-011 Amendment 4 – Executed
- MED-19-011 Amendment 5 – Executed
- Payments for Past Fiscal Years
Iowa Medicaid Resources
- Iowa Medicaid Homepage
- Iowa Medicaid Organization Chart
- Agency Dashboards
- Iowa Health Link
- Informational Letters
Enrollment Queue Only Calls for MBR and Hawki
Sample Appeal Documents
- Blank Claims Appeal Summary
- Contribution Appeal Summary Template
- ME Denial Appeal Summary Template
- ME Review Cancellation Appeal Summary Template
- Redacted Claim Exhibit
- Redacted Med Exempt Denial Letter
- Redacted Med Exempt Survey
Reports
Call Volume Monthly Reports
- February 2019
- March 2019
- April 2019
- May 2019
- June 2019
- July 2019
- August 2019
- September 2019
- October 2019
- November 2019
- December 2019
- January 2020
- February 2020
- March 2020
- April 2020
- May 2020
- June 2020
- July 2020
- August 2020
- September 2020
- October 2020
- November 2020
- December 2020
- January 2021
- February 2021
- March 2021
- April 2021
- May 2021
- June 2021
- July 2021
- August 2021
- September 2021
- October 2021
- November 2021
- December 2021
- January 2022
- February 2022
- March 2022
- April 2022
- May 2022
- June 2022
- July 2022
- August 2022
- September 2022
- October 2022
- November 2022
- December 2022
- January 2023
- February 2023
- March 2023
- April 2023
- May 2023
- June 2023
- July 2023
- August 2023
- September 2023
- October 2023
- November 2023
- December 2023
- January 2024
- February 2024
- March 2024
- April 2024
- May 2024
- June 2024
- July 2024
- August 2024
Amendments
- MED-19-012: Amendment 1
- MED-19-012: Amendment 2
- MED-19-012: Amendment 3
- MED-19-012: Amendment 4
- MED-19-012: Amendment 5
- MED-19-012: Amendment 6
- MED-19-012: Amendment 7
- MED-19-012: Amendment 8
- MED-19-012: Amendment 9
- MED-19-012: Amendment 10
- MED-19-012: Amendment 11
- MED-19-012: Amendment 12
- MED-19-012: Amendment 13
- MED-19-012: Amendment 14
- MED-19-012: Amendment 15
Documents
- MEM - Accessing Language Line/Telecommunications Device for the Deaf (TDD)
- MEM – Calls about Accounts Receivable and Accounts Payable Issues
- MEM – CC – 1095-B Mail Process
- MEM – CC – After Hours Callbacks
- MEM – CC – Creating and Completing Contact Logs
- MEM – CC – Determining Review Date and Issuing Review Paperwork
- MEM – CC – DHS Services Portal Planned Outages
- MEM – CC – Member Calls to Appeal a DHS Decision
- MEM – CC – Member Calls to Submit Phone Application
- MEM – CC – Workers Call to Report an ELIAS System Issue
- MEM – Dental Carrier Good Cause Disenrollment
- MEM – ELIAS Planned Outages
- MEM – MPEP Unplanned Outages
- MEM-Fee-for-Service (FFS) Member Calls Regarding Bills or Refusals of Service
- MEM – Medical Assistance Advisory Council (MAAC) Minutes IA Health Link Public Comment Meeting Minutes
- MEM – Medical Assistance Advisory Council (MAAC) IA Health Link Public Comment Meetings
- MEM – Medical Assistance Advisory Council (MAAC) Minutes
- MEM – Medical Assistance Advisory Council (MAAC) Public Member Employment
- MEM – Medical Assistance Advisory Council (MAAC) Public Member Reimbursement
- MEM – Managed Care Enrollment Form Complete
- MEM – Managed Care Good Cause Disenrollment
- MEM – Managed Care Organization (MCO) Escalated Issues – Member Services
- MEM – Managed Care Quarterly Reports
- MEM – Mass Disenrollment Procedures
- MEM – Managed Care Organization (MCO) Escalated Issues – Member Services
- MEM – Managed Care Organization (MCO) Urgent Issues – Member Services
- MEM – Medical Assistance Advisory Council (MAAC) Agenda
- MEM – Medicare Buy-In Quality Assurance
- MEM – IME Member Services Electronic Communications
- MEM – Medicare E-Mail Process
- MEM - Member Requests for Claims History
- MEM – Annual Reminder
- MEM – Member Calls about Accounts Receivable and Accounts Payable Issues
- MEM - Member Calls about Third-Party Liability Issues
- MEM - Member Calls Involving Appeals
- MEM - Member Calls for Eligibility and Benefits
- MEM-Fee-for-Service (FFS) Member Calls Regarding Bills or Refusals of Service
- MEM – Member Calls Regarding Health Insurance Portability and Accountability Act (HIPAA) Breaches
- MEM – Member Complaints
- MEM - Member Demographic Change – Field Office Notification
- MEM - Member Requests for Claims History
- MEM - Member Services Supply Orders
- MEM – Choice Counseling Policies and Procedures
- MEM – Dental Wellness Plan Carrier Selection
- MEM – Dental Wellness Plan Enrollment Packets
- MEM – IA Health Link Enrollment Packet Reprint
- MEM-IA Health Link Managed Care Enrollment Packets
- MEM-Medical Exemption Processing
- MEM – Member Content Process and Procedure
- MEM – PRV – Potential Fraudulent Call
- MEM – Supplemental Insurance Questionnaire
- MEM – MPEP Planned Outages
- MEM – State Ombudsman and Long Term Care Ombudsman Inquiries
- MEM – Provision of Medical Certificate of Creditable Coverage Requested by Member
- MEM – Publishing to the Member Services Website
- MEM - Member Requests for Publications
- MEM – Responding to Member’s Written Inquiries
- MEM – Supplemental Insurance Questionnaire
- MEM – Updating EPP Date Table in the Medicaid Management Information System (MMIS)
- MEM – Updating the Print Date Table in the Medicaid Management Information System (MMIS)
- MEM – Updating the Enrollment Date Table in the Medicaid Management Information System (MMIS)
- MEM – Tracking Qualified Entity (QE) Discrepancy Activity
- MEM – Managed Care Good Cause Disenrollment
- MEM – Medicare Buy-In Quality Assurance
- MEM - Member Demographic Change – Field Office Notification
- MEM – PRV - Mitigation of an Iowa Medicaid Enterprise (IME)/Managed Care Organization (MCO) Escalated Issue
- PRV – Presumptive Providers (PP) Annual Recertification
- PRV – Qualified Entity (QE) Annual Recertification
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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