October 17, 2019  |  Issue 12  |  Volume 4

Medicaid e-News
News and Announcements:

Guard Your Card
Medicare Open Enrollment is underway and the Centers for Medicare & Medicaid Services (CMS) is reminding Medicare beneficiaries to be vigilant and take precautions to avoid falling victim to healthcare fraud. (Medicaid Open Choice ended September 30, 2019.) 

Scammers are after medical insurance and financial account information and passwords for their monetary gain and may see the increased public outreach activities during Open Enrollment as an opportunity to strike.

CMS is reminding people with Medicare to guard your Medicare card like a credit card, check Medicare claims summary forms for errors, and be wary of unsolicited requests for your Medicare number. Medicare will never call beneficiaries to ask for or check Medicare numbers.

To protect yourself from fraudsters, CMS offers the following security tips:
  • Never accept medical supplies from a door-to-door salesman. If someone comes to your door claiming to be from Medicare, remember that Medicare and Medicaid do not send representatives to your home.
  • Never give your Medicare card, Medicare number, Social Security card, or Social Security number to anyone except your doctor or people you know should have it.
  • Remember, nothing is ever "free." Never accept offers of money or gifts for free medical care.
  • Be wary of providers who tell you that the item or service isn't usually covered, but they "know how to bill Medicare" so Medicare will pay.
  • Always check your medications before leaving the pharmacy to be sure you received the correct medication prescribed, including whether it's a brand or generic name. If you don't get your prescription filled correctly, report the problem to the pharmacist.
  • Report suspected instances of fraud by contacting Medicare's toll-free customer service operations at 1-800-MEDICARE (1-800-633-4227).  You can also go online to find more information  -- www.medicare.gov/fraud
Public Notice
The following public notice has recently been posted on the Department of Human Services (DHS) website:

Changing Your Managed Care Organization
The Member Open Choice Period ended September 30, 2019.

Going forward, members may only change their Managed Care Organization (MCO) during their annual choice period or for reasons of good cause.

Members requesting to change their MCO due to good cause first 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 at 1-800-338-8366. The final decision for disenrollment will be determined by DHS. More information can be found on the DHS website .

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. 

If you currently do not have access to the ELVS web portal, you can register your provider at https://connect.edissweb.com. Each additional user that would like access to the provider's information can complete an Additional Access Request Form. If you have any questions regarding EDISS registration, call 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:

Informational Letters
Informational letters are posted through the Iowa Medicaid Portal Application (IMPA) system and are available on the DHS website.   These letters communicate important policies and procedures for providers and their administrative staff. 
IA Health Link Contacts





Dental Wellness Plan Contacts





Iowa Medicaid Contacts



Success Stories
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 above to read success stories.

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Iowa Medicaid Enterprise | IMECommunications@dhs.state.ia.us | dhs.iowa.gov
611 Fifth Ave., Des Moines, IA 50309