Provider Enrollment

Providers wanting to enroll as an Iowa Medicaid provider must submit an enrollment application to Iowa Medicaid Provider Enrollment Unit. No payment will be made to a provider for services prior to the effective date of the department's approval of an application. The enrollment application is used to screen and verify that provider has met federal regulations and state requirements prior to enrollment.

Iowa Medicaid has developed a Provider Enrollment Process Chart to help prospective providers better understand the process for enrolling with Iowa Medicaid. Once a provider is enrolled with Iowa Medicaid, they must go through the Managed Care Organization (MCO) credentialing process.

Provider Application Fees

Iowa Medicaid will require an application fee for newly enrolling and re-enrolling institutional providers effective August 1, 2016. Code of Federal Regulations section 455.460 requires institutional providers to pay the application fee with initial applications for new enrollment, applications for a new practice location and any re-enrollment.

For more information, please refer to the Frequently Asked Questions or contact Provider Enrollment at 1-800-338-7909 (option 2) or in Des Moines 515-256-4609 (option 2) or by email at IMEProviderEnrollment@dhs.state.ia.us.

Provider Enrollment Documents

Required Provider Enrollment Documents

If you are enrolling in the Iowa Medicaid program for the first time or are already enrolled, but have a new Tax ID, please complete “Section A” of:

How to Enroll as an Ordering or Referring Provider

• Provider Agreement
• Ordering/Referring Provider Application

Providers already enrolled as Iowa Medicaid providers do not need to do anything new.

Practitioners not otherwise enrolled as Iowa Medicaid providers may enroll as ordering/referring providers.

Questions in completing this application may be directed to Iowa Medicaid Provider Enrollment Unit at (800) 338-7909 (option 2) or (515) 256-4609 (option 2).

Sample Documents for HCBS and Habilitation Providers

• Background Check Sample Documents
• HCBS Tools Sample Documents
• Policies and Forms Sample Documents
• New Habilitation Provider Training Webinar
• New Habilitation Provider Training Slides

Enrolling as a Provider in the HCBS Waiver Program

Consumer-Directed Attendant Care (CDAC) Services for Providers

In the HCBS waiver program, members can receive assistance in their own homes. Consumer Directed Attendant Care (CDAC) services are designed to help people do things that they normally would for themselves if they were able.

• CDAC Member Handbook
• CDAC Daily Service Record
• CDAC Agreement Form

If you wish to enroll as an individual CDAC provider

• You can enroll to become an individual CDAC provider to care for people you care about in their home. You can also enroll as a provider in order to get on a list of approved providers. To enroll as a CDAC provider, you may contact the Iowa Medicaid at: Iowa Medicaid Provider Enrollment
  P.O. Box 36450
  Des Moines, IA 50315
  1-800-338-7909
  515-256-4609 (in the Des Moines area only)

Provider Forms

Visit our Provider Forms page to find more provider forms and information.

New CDAC Provider Forms

• 470-2917
• 470-4457
• 470-4612
• 470-4202
• 470-296
• 470-4227
• W-9 Form
• Proof of Age: Proof of age could be a copy of a driver's license, a birth certificate, a State-issued ID or a passport.

Current CDAC Provider Forms

As an active CDAC provider, the above resources, information and CDAC-relevant forms will help you in the administrative process when filing claims for the services that you provide to the consumer.

HCBS Waiver Provider Forms

• 470-2917
• 470-4202
• 470-2965
• IRS Tax Form W-9
• 470-4457
• Training Webinar
• Training Slides
  • Waiver providers are eligible to participate in the Iowa Medicaid's HCBS Waiver program if they meet the standards for the service to be provided.
  • Qualifications are defined on the enrollment application. Your agency or business must meet one of the enrollment qualifications under each service for which you are enrolling.
  • For the Brain Injury Waiver only: Providers involved in direct consumer service must have training regarding or experience with consumers who have a brain injury.

  Chronic Condition Health Home

  A Chronic Condition Health Home enables providers to offer additional services for members with specific chronic conditions. Providers must meet standards outlined by the state and seek patient centered medical home (PCMH) recognition within 12 months of enrolling in the program. To facilitate a team-based, community focused approach, providers participating as a Health Home must connect to the Iowa Health Information Network (IHIN).

  Integrated Health Homes

  An Integrated Health Home (IHH) is a team of professionals, including family and peer support services, working together to provide whole-person, patient-centered, coordinated care for adults with a serious mental illness (SMI) and children with a serious emotional disturbance (SED). This includes individuals currently receiving Targeted Case Management (TCM) and Case Management through Medicaid- funded Habilitation. Care coordination is provided for all aspects of the individual's life and for transitions of care the individual may experience. The IHH is required to assist individuals with their paperwork and guide them through the application process for benefits for which they qualify. The IHH is required to coordinate all services for an individual, including medical, behavioral, and community services regardless of the funding sources for those services.

  HCBS Provider Quality Self-Assessment

  The HCBS Provider Quality Self-Assessment is required of all providers enrolled for the services identified, regardless of whether those services are currently being provided. The self-assessment must be completed, submitted and approved at application annually and anytime there is a change in the provider's enrollment that warrants an updated self-assessment.

  Excluded Individuals and Entities

  The excluded individuals and entities page is a searchable, online database for all individuals and entities excluded from participation with Iowa Medicaid. This is a national list maintained by the US Department of Health and Human Services, Office of the Inspector General and is regularly updated.

  Program Integrity Provisions of the ACA for Provider Enrollment and Screening

  To improve the program integrity of the Medicare, Medicaid, and the Childrens Health Insurance Program (CHIP) programs, the Patient Protection and Affordable Care Act (ACA) requires these programs to screen all enrolling and re-enrolling providers associated with the program, according to the federally identified categorical risk level of a provider type.

  For Iowa Medicaid, the new requirements are more extensive than the former screening requirements and include enrolling providers who were not previously required to enroll in Medicaid. The changes will allow Medicaid programs to more effectively monitor and restrict those individuals or entities who purposely defraud and abuse the Medicaid system.

  Screening Levels and New Screening Requirements

  The federally identified categorical risk level of a provider type (limited, moderate, high) is based on national statistics of the provider types of risk of fraud, waste or abuse. The following outlines each risk level and the corresponding new screening requirements for provider types in each risk category:

  Limited Risk

  Limited risk providers will be subject to verification that the provider meets applicable federal regulations or state requirements for their specific provider type, state licensure verification and database checks both before and after enrollment in order to ensure that applicable enrollment criteria are met.
  Screening Requirements

  • Provider license check List of Excluded Individuals and Entities(LEIE).
  • Check at enrollment and monthly.
  • System for Award Management (SAM).
  • Information on providers who have been debarred, suspended, excluded or disqualified.
  • Check at enrollment and monthly Social Security Administration (SSA) Death Master File.
  • Nation-wide check National Plan and Provider Enumeration Systems (NPPES).
  • To check National Provider Identifiers Medicare Exclusion Database (MED) Medicaid and Childrens Health Insurance Program State Information Sharing System (MCSIS).
  • List of Terminated providers in all states Provider Enrollment Chain and Ownership System (PECOS).
  • Providers enrolled in Medicare.

  Moderate Risk

  Moderate risk providers will be subject to pre- and post- enrollment site visits wherein Iowa Medicaid will verify that the information submitted by the provider is accurate and will determine compliance with federal and state enrollment requirements. Iowa Medicaid is not required to conduct site visits on those providers who have already been screened as a moderate risk provider type by Medicare or another States Medicaid or CHIP program within the previous twelve months.

  Screening Requirements

  • All screening requirements associated with the Limited risk category
  • Conduct Pre- and Post- enrollment site visits

  High Risk

  High-risk providers include newly enrolling home health agencies and Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) suppliers or enrolling a new practice location. In addition to those screening procedures that are conducted under the limited and moderate risk categories, these providers will be subject to criminal background checks and fingerprinting.

  Screening Requirements

  • All screening requirements associated with the Limited and Moderate risk categories.
  • Conduct criminal background checks.
  • Obtain the providers fingerprints.