August 17, 2018  |  Issue 15  |  Volume 3
Medicaid e-News
News and Announcements:
New Call Center Hours for Provider Services

The Iowa Medicaid Enterprise (IME) Provider Services Call Center hours of operation is now 8:00 a.m. to 5 p.m. Central Time, Monday through Friday.

Authorized Representative for Managed Care Appeals

Managed care appeals are mandated by Federal law. Federal regulations allow providers and authorized representatives to file an appeal on behalf of a Medicaid member for managed care appeals when the member has given their express written consent. 

While the Department has been complying with federal regulations, there was not a consistent way to obtain written consent from members. 

In an effort to streamline the process, the Department, Managed Care Organizations (MCOs), and dental carriers are now utilizing form 470-5526, Authorized Representative for Managed Care Appeals, to obtain the member's consent. 

Form 470-5526 will be used to appoint an individual, organization or provider to act on behalf of the Medicaid member during the appeals process.  This form will be used for the MCOs' and dental carriers' first level appeals process and the Department's state fair hearing process. 

More information can be found in Informational Letter 1922.

Reminders:
Good Cause
Remember, members  requesting to change their MCO due to 'Good Cause,' f irst must contact their current MCO to go through their grievance process for resolution. If the issue has not been resolved following the decision of the grievance, the member may call Iowa Medicaid Member Services. The final decision for disenrollment will be determined by DHS. For more information click here.

Provider Tools and Resources:
Providers are Encouraged to 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. 
 
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:


IA Health Link Success Stories
IA Health Link is a managed care program that works to make sure members get the health care that they need. Click the image below to read the success stories.



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.

Iowa Medicaid Contacts
Iowa Medicaid Provider Services
1-800-338-7909
IA Health Link Member Services
1-800-600-4441

1-800-464-9484
IA Health Link Provider Services
1-800-454-3730

1-888-650-3462
Dental Wellness Plan Member Services
1-888-472-2793

1-855-247-6262
Dental Wellness Plan Provider Services
1-888-472-1205

1-855-856-6262

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
The Iowa Medicaid Enterprise (IME), has been named a 2016 All Star Award winner by  Constant Contact , part of the  Endurance International Group, Inc.'s  (Nasdaq: EIGI) family of brands and the trusted marketing advisor to hundreds of thousands of small organizations worldwide. The annual award recognizes the most successful 10 percent of Constant Contact's customer base, based on their significant achievements using email marketing to engage their customer base and drive results for their organization during the prior year.