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Level of Care Process-Clarification
The IA Health Link managed care program began on April 1, 2016, with a focus on the provision of services and quality of care in Long Term Care programs. The Iowa Medicaid Enterprise (IME) has issued a clarification of the process for submission of Level of Care (LOC) Certification for members in a nursing facility.
As required by federal regulation, facilities must conduct a comprehensive, accurate, standardized, reproducible assessment of each resident's functional ability to determine the appropriate LOC. The results of the assessment are used to develop, review, and revise the resident's comprehensive plan of care, potentially resulting in discharge.
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Waiver Provider Requirements: Reminder for Iowa Medicaid Individual Consumer Directed Attendant Care (CDAC) Providers
The IA Health Link program launched on April 1, 2016, and while Managed Care Organizations (MCOs) are administering the program, the policies of the Iowa Medicaid Enterprise (IME) remain consistent with all three MCOs.
All services provided must be approved by the member's Care Manager or Case Manager through a written CDAC Agreement which has been signed by the provider
and the member. For more details view
Informational Letter 1675-MC.
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IA Health Link Newborn Coverage
In situations where a Managed Care Organization (MCO) enrolled Medicaid member gives birth, the newborn is automatically enrolled with the mother's MCO. The member must notify the MCO of the birth and follow the MCO's policies. Please refer to the MCO training materials and provider manuals on the DHS website under Managed Care Organization (MCO) Specific Materials.
Automatic assignment to the mother's MCO is done only after the Medicaid enrolled mother has completed the necessary enrollment application with the Iowa Department of Human Services (DHS) Income Maintenance Worker. All DHS enrollment processes should continue to be followed.
Once the newborn is determined eligible and the MCO assignment has occurred, the member will also have 90 days to change enrollment if the mother or guardian chooses to change to a different MCO. Choosing a different MCO during this period may be done without cause.
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Managed Care Cards and Medicaid ID Numbers
All three Managed Care Organizations (MCOs) include the member's Medicaid ID number on the member's MCO ID card. The Amerigroup of Iowa, Inc. member ID card refers to the number as "Medicaid number." The AmeriHealth Caritas of Iowa, Inc. member ID card refers to the number as "State ID." UnitedHealthcare Plan of the River Valley, Inc. uses the Medicaid ID as the MCO ID number and is referred to on the card as "Member ID."
To view samples of the MCO cards click here.
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Iowa Family Planning Network Waiver Demonstration Renewal
In accordance with Affordable Care Act regulations for section 1115 demonstrations, the Department of Human Services (DHS) is posting notice of the request to extend the Iowa Family Planning Network Demonstration Waiver. The public is encouraged to review the renewal document and the schedule for public hearings.
Comments concerning this notice on the waiver renewal may be sent to
klindsa@dhs.state.ia.us
or addressed to Kelly Lindsay, Iowa Department of Human Services, Hoover State Office Building, 1305 E. Walnut Street, Des Moines, IA 50319-0114 for a period of thirty (30) days from the date of this notice.
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We Want to Hear from You!
Join Iowa Medicaid, The Iowa Department of Human Services, and representatives from each of the Managed Care Organizations (MCOs) for a public comment meeting to voice your comments.
The next public comment meeting will be at the Hilton Garden Inn, River City Ballroom, 2702 Mid-American Dr., Council Bluffs, IA, 51501, on June 7, 2016, from 3 to 5 p.m.
Download a printable flyer to help get the word out in your community
here.
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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). The ELVS web portal allows for multiple eligibility checks, where as the ELVS phone system only allows for one at a time.
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.
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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.
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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:
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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.
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MCO Member Services
1-800-600-4441
1-855-332-2440
1-800-464-9484
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Non-Emergency Medical Transportation
Members may contact their assigned
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
_________________
Medicaid
Fee-for-Service
Access2Care/TMS
1-866-572-7662
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New 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.
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Communications Toolkit
The IA Health Link Communications is full of resources including FAQs, social media posts, images, links and more. Download it below:
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