April 8, 2016  |  Issue 13  |  Volume 1
Medicaid e-News
Important Reminders:
Out-of-Network Providers
If a member sees a Medicaid provider who is not in their MCO's network but is a Medicaid-enrolled provider, the provider may accept the 90 percent out-of-network rate from the member's MCO or choose not to see the member. Providers who accept out-of-network payments from an MCO may only bill the member for established cost sharing and patient liability. A Medicaid-enrolled provider who refuses to accept an MCO's out-of-network rate cannot bill the patient directly. 

Prior Authorization Requirements 
From April 1-30, 2016, no prior authorizations (PAs) will be required, except for pharmacy drug claims.
 
During the first 90 days of the transition, all existing prior authorizations will be honored. During this 90-day grace period, providers will be able to establish new authorizations following the policies of the member's selected MCO.
 
Medicaid providers, whether in-network or out-of-network, must follow the MCO's PA requirements included in the health plans' Provider Manuals. The MCO's Provider Manuals were recently updated and can be found here.

The Iowa Medicaid Enterprise (IME) has put together a 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 here .

Informational Letter 1628-MC provides important direction on the PA process during this transition. Please read it carefully. It can be found here.

Verify Eligibility
The Eligibility and Verification Information System (ELVS) line is very busy during the first of the month. The ELVS web portal  is another option for providers in lieu of calling the ELVS line but each provider must enroll through the Electronic Data Interchange Support Services (EDISS).

Login ID and password may be obtained through EDISS by submitting the following Access Request Form to EDISS or calling EDISS at 1-800-967-7902. 

For more information, please see Informational Letter 1650-MC available here.
 
Non-Emergency Medical Transportation
Each of the Managed Care Organizations (MCOs) has selected a transportation vendor. Members may contact their assigned MCO's non-emergency medical transportation (NEMT) broker at the numbers below to schedule their  NEMT services:

Amerigroup Iowa Inc.
Logisiticare
1-844-544-1389

AmeriHealth Caritas, Iowa Inc.
Access2Care
1-855-346-9760

UnitedHealthcare Plan of the River Valley, Inc.
MTM
1-888-513-1613

Informational Letters:
New Provider Informational Letters
Informational letters are posted through the Iowa Medicaid Portal Application (IMPA) system and are available on the DHS website  here . Recent informational letters are featured below. 

These letters communicate important policies and procedures for providers and their administrative staff. Providers should continue to watch closely for updates during the implementation period. 
  • 1637-MC Daily Nursing Facility Room and Board Reimbursement
  • 1648-MC Update-Electronic Billing
  • 1651-MC Community-Based Neurobehavioral Rehabilitation Services (CNRS)
  • 1657-MC Billing for Medicaid Services - Updated
  • 1658-MC HCBS Waiver and State Plan HCBS Amendments
Tools and Resources:
Managed Care Organization Provider Resource Pages Available
Comprehensive resource pages are available for each Managed Care Organization (MCO), featuring provider training manuals, webinars and important updates. You may view them below:


Resource Guide for Providers' Front Desk Staff
The Iowa Medicaid Enterprise (IME) has put together a useful tool for administrative staff which includes important phone numbers, claims submission information and more.

Download and print the Managed Care Quick Reference Guide here.

Looking for an Old Issue of the Medicaid e-News?
Each edition features useful tools and important updates. Now you can quickly access old issues to find what your looking for. Visit the Iowa Medicaid newsletter page 
where you'll find links to each issue.

Coverage has Begun!
Choice Continues:
Members can continue to make changes in MCO selection for 
any reason until 
June 16, 2016, and after for 'Good Cause.'
 
MCO Member Services
Updated Communications Toolkit

The IA Health Link Communications Toolkit has been updated with the April 1, 2016, launch date and is full of resources including FAQs, social media posts, images, links and more. Download it below:
 



Iowa Medicaid Enterprise | IMECommunications@dhs.state.ia.us | dhs.iowa.gov
100 Army Post Rd., Des Moines, IA 50315