December 16, 2016  |  Issue 30  |  Volume 1
Medicaid e-News
Important Update:
Member Mailings
Important mailings are being sent to all Iowa Medicaid members. The mailings identified below will be sent on ten different days over a five-week period. Following this initial mailing, the Annual Enrollment Letters will be ongoing and sent monthly. The mailings identified below will begin arriving in mailboxes in the coming weeks.

Please note that members do NOT need to do anything unless if they wish to switch to another MCO. If a member wishes to switch to another MCO, please direct them to contact Iowa Medicaid Member Services at 1-800-338-8366.
  • IA Health Link Annual Enrollment Letter: Members enrolled in the IA Health Link managed care program have an annual enrollment period each year when they may change their Managed Care Organization (MCO) for any reason. The annual enrollment period is based on their initial enrollment in managed care. This mailing will begin in December 2016, and will be ongoing. You can view a sample of this mailing here.
  • IA Health Link and Dental Wellness Plan Annual Enrollment Letter: Iowa Health and Wellness Plan (IHAWP) members are enrolled in the IA Health Link managed care program and the Dental Wellness Plan. These members have an annual enrollment period each year when they may change their MCO and dental carrier for any reason. The annual enrollment period is based on their initial enrollment in managed care. This mailing will begin in December 2016, and will be ongoing. You can view a sample of this mailing here.
  • Notice of Privacy Practices: Every three years the Department of Human Services (DHS) is required to mail the Notice of Privacy Practices to all Iowa Medicaid beneficiaries. This notice is included in the mailings identified above. All Iowa Medicaid members who are not enrolled in managed care, or are in the hawk-i program, will receive a separate mailing containing the Notice of Privacy Practices. This is a one-time mailing and will begin in December 2016. You can view a sample of this mailing here.
For more information view Informational Letter 1751-MC-FFS-D.

Guidance on Wrap Payments
To assist Rural Health Clinics (RHCs) and Federally Qualified Health Clinics (FQHCs), the Iowa Medicaid Enterprise (IME) has compiled a Q&A related to wrap payment submissions with responses from each Managed Care Organization (MCO). Please see below.

Do RHCs and FQHCs have to submit requests to the MCOs, or will data requests be automatically sent to the RHCs and FQHCs?
  • Amerigroup (AGP): RHCs and FQHCs should submit their requests to AGP, at this time.
  • AmeriHealth Caritas (ACIA): RHCs and FQHCs should submit their requests to ACIA.
  • UnitedHealthcare (UHC): RHCs and FQHCs should submit their requests to UHC.

Do RHCs and FQHCs have to request this data each quarter?
  • AGP: Yes, requests should be sent each quarter to AGP, at this time.
  • ACIA: Yes, requests should be sent each quarter to ACIA and should include all required information in order to ensure ACIA is generating the data and submitting it to the correct individual each time it is requested.
  • UHC: With the initial request, RHCs and FQHCs can indicate it as a one-time request or on-going. If it is on-going, they do not need to submit a request each quarter. 

Where should requests for wrap data be sent within each MCO?

When should requests for wrap payment data be sent to each MCO?
  • AGP: Wrap payment data requests should be sent at the end of the reporting quarter to be in alignment with Form 470-3495 (Rev. 7/16). It is due 30 days from end of previous quarter.
  • ACIA: Requests should be submitted prior to the end of each quarter to ensure the report will be delivered in a timely manner for providers to meet the IME report filing deadlines.
  • UHC: If it is a new request, it should be submitted no later than the last day of the end of the given quarter (e.g. report must be requested by Sept. 30 for a quarter ending Sept. 30 and the Managed Care Wraparound Payment request is due Oct. 31). Providers can begin submitting requests immediately.
 
What information needs to be included by RHCs and FQHCs to MCOs for the data request?
  • AGP:
    • Name of RHC/FQHC
    • Tax identification number
    • NPI number(s)
    • Name of contact to send the report
    • Email address of contact to send the report
    • Telephone number of the contact where the report is to be sent
  • ACIA:
    • Name of RHC
    • Tax identification number
    • NPI number(s)
    • Name of contact to send the report
    • Email address of contact to send the report
    • Telephone number of the contact where the report is to be sent
  • UHC:
    • Name of RHC
    • Tax identification number
    • NPI number(s)
    • Name of contact to send the report
    • Email address of contact to send the report
    • Indicate if it is a one-time or on-going request

For the reports due December 31, 2016, when can RHCs and FQHCs expect to receive data?
  • AGP: The RHCs and FQHCs can expect data within 10 business days of the request.
  • ACIA: The RHCs and FQHCs can expect the data no later than December 20, 2016, assuming the data is requested by November, 30, 2016, and includes all needed information required. ACIA will make every attempt to get these out earlier for any request from RHCs and FQHCs that come in prior to November, 30, 2016.
  • UHC: For the initial requests, the anticipated timeline is 4-6 weeks from the date of the request, and no later than December 22, 2016.
 
What is the ongoing timeframes that RHCs and FQHCs should expect the data to be sent from the MCOs once requested?
  • AGP: The RHCs and FQHCs can expect data within 10 business days of the request.
  • ACIA: Assuming the requests are received prior to the end of the quarter, RHCs and FQHCs should expect to receive the data by no later than the 20th of the month following the quarter.
  • UHC: The RHCs and FQHCs can expect data no later than one week prior to the due date of the report (e.g. if report is due October 31, UHC will distribute the data no later than October 24).

How do RHCs and FQHCs notify the MCOs when the contact with the secure email address changes?
  • AGP: The provider should submit a request to iowamedicaid@amerigroup.com. AGP will reply to the request. If a provider/person receiving the response has not signed up to receive secure email, they will be prompted to do so at that time.  
  • ACIA: The RHCs and FQHCs should notify ACIA when submitting the request to receive the data each quarter.
  • UHC: The RHCs and FQHCs should notify UHC following the same process as used for the initial request, by emailing Iowa_Wraparound_Request@uhc.com.
Important Reminder:
Public Comment Meeting: Fort Madison 
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 Public Comment Meetings webpage for more information.

The next public comment meeting will take place  at the Fort Madison Public Library 1920 Avenue E, Fort Madison, IA 52627 , on January 12, 2017, from 5 to 7 p.m.

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

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.
 
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.
 
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Member Services
Provider Services
Iowa Medicaid Provider Services
1-800-338-7909

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