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Not All Iowa Medicaid Members are Included in the Transition to Managed Care
There are some Iowa Medicaid members who are not included in the transition to manged care. These members will continue to use their Iowa Medicaid member eligibility cards. They will not be issued new ID cards. This includes members in the following groups or programs:
- Health Insurance Premium Payment program (HIPP)
- Medicare Savings Program (MSP) only.
- Qualified Medicare Beneficiary plan (QMB)
- Specified Low-Income Medicare Beneficiary (SLMB)
- Medically Needy program, also known as the spenddown program
- Presumptively eligible members (subject to change once ongoing eligibility is determined)
- Newly eligible members who are in their Fee-for-Service period before their MCO coverage begins
Some members will remain in Medicaid Fee-for-Service (FFS), though they may choose to opt-in to the managed care program:
- Members who are enrolled with the PACE program
- American Indian or Alaskan Natives
When providers verify eligibility through the Eligibility Verification System (ELVS), it will indicate their eligibility type, including whether the member has coverage through an MCO or if they are covered through FFS.
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Claim Payments Have Begun
All three MCOs have begun paying claims. While many providers are accustomed to an end-of-month billing cycle, providers are encouraged to begin submitting claims early. This will allow providers time to ensure they are prepared to file claims with the new MCOs, and be paid without delay.
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Iowa Health and Wellness Plan Update
The Iowa Department of Human Services (DHS) will hold public hearings on the renewal of the Iowa Wellness Plan Demonstration Waiver, which is set to expire December 31, 2016. DHS intends to extend this waiver for an additional three years.
In addition, DHS is seeking to terminate the Marketplace Choice Demonstration Waiver, which is also set to expire December 31, 2016, as there are no current Marketplace Choice enrollees. The State will continue to contract with managed care organizations to deliver high quality health care services for the majority of Iowa Wellness beneficiaries.
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Resource Guide for Providers' Front Desk Staff
The Iowa Medicaid Enterprise (IME) has put together a useful tool for administrative staff which includes important phone numbers, claims submission information and more.
Download and print the Managed Care Quick Reference Guide here.
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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).
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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Prior Authorization Requirements
From April 1-30, 2016, no prior authorizations (PAs) will be required,
except for pharmacy drug claims.
During the first 90 days of the transition, all existing prior authorizations will be honored. During this 90-day grace period, providers will be able to establish new authorizations following the policies of the member's selected MCO.
Download and print the PA requirements by plan
here
.
Informational Letter 1628-MC provides important direction on the PA process during this transition. Please read it carefully. It can be found here.
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Managed Care Organization Provider Resource Pages Available
Comprehensive resource pages are available for each Managed Care Organization (MCO), featuring provider training manuals, webinars and important updates. You may view them below:
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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.
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Choice Continues:
Members can continue to make changes in MCO selection for
any reason until
June 16, 2016, and after for 'Good Cause.'
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MCO Member Services
1-800-600-4441
1-855-332-2440
1-800-464-9484
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Non-Emergency Medical Transportation
Each of the Managed Care Organizations (MCOs) has selected a transportation vendor. Members may contact their assigned MCO's
non-emergency medical transportation (NEMT) broker at the numbers below to schedule their
NEMT services:
Amerigroup Iowa Inc.
Logisiticare
1-844-544-1389
AmeriHealth Caritas, Iowa Inc.
Access2Care
1-855-346-9760
UnitedHealthcare Plan of the River Valley, Inc.
MTM
1-888-513-1613
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New Provider 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.
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Updated Communications Toolkit
The IA Health Link Communications Toolkit has been updated with the April 1, 2016, launch date and is full of resources including FAQs, social media posts, images, links and more. Download it below:
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