October 4, 2016  |  Issue 27  |  Volume 1
Medicaid e-News
Important Reminders:
IA Health Link Public Comment Meetings 
The Iowa Department of Human Services continues holding public comment meetings to gather input on the IA Health Link managed care program. Meetings are held once per month, in varying locations throughout Iowa. Access the IA Health Link 2016 Public Comment Meetings webpage for more information.

The next public comment meeting will be located in 
Sioux City at the Western Iowa Tech Community College, Cargil Auditorium (D103), 4647 Stone Ave., Sioux City, IA 51106, on October 11, 2016, from 3 to 5 p.m.

Help get the word out in your community by printing and posting a flyer available for download here!

Services Provided to IA Health Link Members Must be Billed to Their Managed Care Organization for Reimbursement 
An Iowa Medicaid member will never be forced to pay out-of-pocket for an Iowa Medicaid covered service from an Iowa Medicaid provider. If the provider is not enrolled with the member's Managed Care Organization (MCO), the provider may accept the out-of-network rate from the MCO, or choose not to see the member.

Important Note: A provider who knowingly treats a Medicaid member cannot bill the member for the rate difference of services rendered. If a Medicaid provider refuses to accept the out-of-network rate, they cannot bill the patient directly. Members may be charged for services that are not covered by Iowa Medicaid, or are not medically necessary. However, per the Iowa Administrative Code 79.9(4) "Recipients must be informed before the service is provided that the recipient will be responsible for the bill if a non-covered service is provided."

Tools and Resources:
Prior Authorization Summary by Plan 
The Iowa Medicaid Enterprise (IME) has put together a prior authorization (PA) summary by plan. Providers can quickly view and compare PA requirements for each plan with this easy-to-use chart. This chart has been updated with the most current requirements for each Managed Care Organization (MCO). View the PA requirements by plan here.
 
Vision Benefit Guide Available Now!
The Iowa Medicaid Enterprise (IME) has put together a vision benefit summary by plan for the IA Health Link manged care program. Providers can quickly view key contact information and requirements for each plan and each coverage group with this easy-to-use chart. View the vision benefit guide here.

Provider Resource Pages
Comprehensive provider resource pages are available for each Managed Care Organization (MCO), featuring provider training manuals, webinars and important updates. View them below:


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 and batch submission, 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.
 
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.

Provider Services

TAKE ACTION: Provider Enrollment Renewal 2016
Provider enrollment renewal is an Affordable Care Act (ACA) requirement for all providers in order to stay active with the Iowa Medicaid Enterprise (IME). This includes providers who were previously enrolled with Magellan and who recently enrolled with the IME. 

More information is available here.


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. 

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

Copyright © 2016. All Rights Reserved.