June 5, 2018  |  Issue 5  |  Volume 3
Medicaid e-News
News and Announcements:
Public Comment Period For Alternative Benefit Plan Amendments

Starting July 1, 2018, an annual benefit limit will be implemented for adult members enrolled in the Dental Wellness Plan (DWP). (Dental benefits for children will not be affected by these changes.)

Covered benefits will remain the same; however, effective July 1, 2018, the annual benefit maximum for each DWP member will be $1,000 for the next state fiscal year, which is July 1, 2018 through June 30, 2019. 

This does not include preventive, diagnostic or emergency dental services, anesthesia, and fabrication of dentures. Here are some examples of dental services that do not count toward a member's annual benefit maximum: exams, cleanings, X-rays, and fluoride.

Additionally, replacement dentures will be limited to one every five years per member with the possibility of obtaining prior authorization for medical necessity replacement dentures prior to expiration of the five-year period.

The Iowa Department of Human Services (DHS) is making these changes to ensure the DWP is sustainable long term.

DHS is currently accepting public comments on the new annual benefit limits provided under the DWP. All public comments must be received by June 29 at 4:30 p.m.

New IA Health Link MCO Selected

DHS is pleased to announce the selection of an additional Managed Care Organization (MCO), Iowa Total Care.  This provides additional options and choice for our members. 

Iowa Total Care will begin providing coverage for IA Health Link members July 1, 2019. Members will be notified by mail when they are able to select Iowa Total Care as their MCO. More information will be posted on our website in the coming months.

Members may continue to change their MCO during their annual choice period or throughout the year and for reasons of 'good cause.'

Public Notices

The following public notices and requests for comment have recently been posted on the Department's website:

Home- and Community-Based Services Amendments: 
The HCBS waiver amendments include changes to performance measures, and also reflect new federal managed care regulations for processing participant grievances and appeals through the MCOs:

New Administrative Rules for Crisis Response and Subacute Mental Health Services

Providers enrolled with the Iowa Medicaid Enterprise (IME) to deliver Crisis Response and Subacute Mental Health services should be aware of new administrative rules that went into effect February 8, 2018.

These rules, which are outlined in detail in  Informational Letter (IL) 1909, include provider qualifications, service requirements, and reimbursement for Crisis Response and Subacute Mental Health Services.

Information about enrolling with IME to deliver these services can be found in IL 1874.

Iowa Medicaid Process Improvement Working Group Updates Available Online

The purpose of the Process Improvement Working Group is to provide the Medicaid Director with an in-depth review of the current Medicaid processes and then work with Medicaid staff, the Managed Care Organizations and providers to help improve the processes. The group consists of various Medicaid providers from across the state.

The group meets by invitation only every few weeks. The group continues to discuss possible process or communication improvements for a variety of topics related to Medicaid and Managed Care, including: claims, prior authorizations, benefits, eligibility, reimbursement, clinical and quality outcomes, transparency, and credentialing.

A list of meeting minutes and the group's work plan can be found on the Department's website

Claims Definitions

A frequently asked question of the Department is to define the different types of claims used in reporting data. Here are some claims definitions:

Clean Claims: The claim is on the appropriate form, identifies the service provider that provided service sufficiently to verify, if necessary, affiliation status, patient status and includes any identifying numbers and service codes necessary for processing. 

Denied Claims: Claim is received and services are not covered benefits, are duplicate or have other substantial issues that prevent payment.
Suspended Claim: Claim is pending internal review for medical necessity and/or may need additional information to be submitted for processing.
Rejected Claim: Claims that don't meet minimum data requirements or basic format are rejected and not sent through processing.  

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:

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 
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Iowa Medicaid Contacts
Iowa Medicaid Provider Services
IA Health Link Member Services

IA Health Link Provider Services

Dental Wellness Plan Member Services

Dental Wellness Plan Provider Services


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.