WellCare of Iowa, Inc. Reassignment
As a reminder, WellCare of Iowa, Inc. is no longer an available managed care organization (MCO) option through the IA Health Link program. Members who were initially assigned to WellCare of Iowa, Inc., or had chosen WellCare of Iowa, Inc., have been reassigned to one of the three available MCOs. This reassignment is based on a random algorithm, dividing members evenly among the MCOs.
Impacted members will receive a reassignment letter the first week of February to notify them of this change. The reassignment letter can be viewed
here
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Updates for Psychiatric Medical Institutions for Children
Direction has been provided to Psychiatric Medical Institutions for Children (PMIC) providers regarding billing the Iowa Medicaid Enterprise (IME) for PMIC services beginning January 1, 2016, until the launch of the IA Health Link program on March 1, 2016, pending final federal approval.
The Iowa Plan ended December 31, 2015. For dates of service on or after January 1, 2016, the IME is responsible for coverage of Medicaid funded mental health and substance abuse services previously paid through Magellan until the launch of the IA Health Link program.
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Provider Training Continues
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Contracting Continues
Providers are encouraged to continue working with the three managed care organizations (MCOs) to complete contracts and credentialing requirements in time for the anticipated March 1, 2016, launch date. Find the
MCO contacts here.
Iowa providers have signed more than 82,364 contracts with the MCOs. Each plan has enrolled over 79 percent of the currently active fee-for-service Iowa providers in their network. Nearly 45 percent of current providers have signed with all 3 MCOs.
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Managed Care Organization Provider Resource Pages Now Available
Comprehensive resource pages are now available for each Managed Care Organization (MCO), featuring provider training manuals, webinars and important updates. You may view them below:
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Help get the word out in your community!
Iowa Medicaid has scheduled several member training events in communities across Iowa. Promotional flyers are available below. These can be printed and posted at clinics, on community bulletin boards and used as handouts.
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Reminder: Provider Informational Letters
Informational letters are posted through the Iowa Medicaid Portal Application (IMPA) system and are available on the DHS website here.
These letters communicate important policies and procedures for providers and their administrative staff. Providers should watch closely for updates during the transition period.
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Home and Community Based Services Waiver Statewide Transition Plan
The Centers for Medicare and Medicaid Services (CMS) have issued regulations that define the settings in which it is permissible for states to pay for Medicaid Home and Community-Based Services (HCBS).
The purpose of these regulations are to ensure that individuals receive Medicaid HCBS in settings that are integrated in and support full access to the greater community. This includes opportunities to seek employment and work in competitive and integrated settings, engage in community life, control personal resources and receive services in the community, to the same degree as individuals who do not receive HCBS.
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Prior Authorization Process Clarification
Informational Letter 1591-MC directed providers on the Prior Authorization (PA) process for the IA Health Link program. Further clarification on this process for both pharmacy drugs that require a PA, and all other services requiring a PA, can be found in
Informational Letter 1607-MC.
PAs are used by the Iowa Medicaid Enterprise (IME) to ensure program integrity, by requiring that all services are medically necessary. The MCOs will honor existing IME PAs for 90 days for all services and providers.
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IA Health Link coverage begins March 1, 2016.
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Managed Care Organizations:
1-800-600-4441
1-855-332-2440
1-800-464-9484
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Current Toolkits
The IA Health Link toolkits are full of resources including FAQs, social media posts, images, links and more. View the links below.
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