Medicaid Managed Care
MCO Quarterly Data (updated 12/20/16)
MCO's and DHS Training and Webinar Schedule (updated 3/14/16)
IA Health Link Launch Date Update (updated 3/29/16)
We're here to help you! Contact:
Director of Governmental Relations/ Member Services
MCO Contact information:
Managed Care Organization
Provider-Specific Contact and Phone Number
Amerigroup Iowa, Inc.
AmeriHealth Caritas Iowa, Inc.
UnitedHealthcare Plan of the River Valley, Inc.
New Providers: IowaCommunityNetwork@uhc.com
Existing Providers: Contact your current contract manager
MCO Website Portals:
State-approved MCO provider manuals (Updated 3/14/16):
- Amerigroup Iowa, Inc.
- AmeriHealth Caritas Iowa, Inc.
- UnitedHealthcare Plan of the River Valley, Inc.
MCO Orientation Materials (Updated 3/14/16):
- Amerigroup Provider Orientation Packet
- Amerigroup LTSS Provider Orientation Packet
- Amerigroup NF Provider Orientation
- AmeriHealth Provider Orientation Packet
- AmeriHealth LTSS Provider Orientation
- UnitedHealthcare LTC Provider Information
- UnitedHealthcare LTSS Provider Orientation Packet
- UnitedHealthcare NF Provider Orientation
Universal Credentialing Form: Providers, who have not already credentialed and contracted with the MCOs and desire to contract, should complete the Universal Credentialing Form and submit to the MCOs. Access the Iowa Medicaid application form here and the Home and Community-Based Services application here. Recall that providers still need to ensure that they are enrolled with the Iowa Medicaid program in addition to any MCO with whom they intend to contract. Additionally, to further help streamline the credentialing process, IME issued letters to all MCOs this week deeming credentialing status under the Iowa Medicaid program for all the MCOs.
MCO Rate Floor Informational Letter 1562. The floor for nursing homes will be the rate in effect July 1, 2015, which includes rebase and the provider assessment add-on. The floor for direct-care HCBS waiver services will be a provider-specific claim rate per service type and per waiver type. This rate was derived based on a weighted average of state fiscal year 2015 data. Non-direct HCBS waiver services do not have a specified floor and it will be 100 percent of the fee schedule when there is one or negotiated where there is not a fee-schedule.
Prior Authorization Informational Letter 1628. Typically, long term care services do not require PA. Instead, these services are established based on level of care (LOC) determinations and, for those on Home and Community Based Services (HCBS) waivers, service plan determinations.
- LOC and service plans will be reviewed and updated on the regular renewal schedule.
- After March 31, all Individual Consumer Directed Attendant Care (CDAC) providers enrolled with Iowa Medicaid will be considered enrolled and contracted with the participating MCOs. They will be paid at 100 percent of the established rate floor. Claims must be submitted directly to the appropriate MCO, adhering to the MCO’s claims submission and timeliness guidelines. Services will continue to require approval through the member’s case management agency and/or the MCO’s community case manager.
- Services may only be modified through an updated assessment. Assessments may only be updated if the member’s needs have changed or at annual review.
Provider Network Fact sheet which can be accessed here.
- Medicaid Modernization Homepage (DHS)
- IA Health Link Public Comment Meeting Schedule
- DHS Informational Letters
- Provider Toolkit
- MCO Comparison Chart: Value-Added Services
- Stakeholder and Community Partner Toolkit
- Bidders Letters of Intent
- Amended RFP
Member-Only Managed Care Readiness Toolkit
The different sections of the toolkit provides members with the resources to better prepare for managed care:
- Determining Your Readiness for Managed Care.
- Managed Care Terms.
- Developing your value proposition.
- What metrics you should be tracking.
- How to prepare for discussions about contracting with Managed Care Organizations.
- Legal contracting due diligence.
Medicaid Managed Care Background
- 2012 Medicaid Managed Care Enrollment Report (Medicaid.gov)
- Medicaid Managed Care: Key Data, Trends, and Issues (Kaiser Family Foundation, 2012)