Referral

IA Health Link

Medicaid Managed Care

On April 1, 2016, the Iowa Department of Human Services transitioned most Iowa Medicaid members to a managed care program called IA Health Link. Most Iowa Medicaid members are enrolled in IA Health Link, which provides coverage through two managed care organizations (MCOs). Providers who care for Medicaid members must contract with the MCOs.

Medical group

EPSDT Care for Kids

EPSDT Care for Kids is Iowa's Early and Periodic, Screening, Diagnosis and Treatment program for children who are enrolled in Medicaid. Care for Kids services are free to children enrolled in Medicaid. EPSDT services include:

  • health history
  • physical exam
  • growth and development assessment
  • vision and hearing screening
  • dental screening and education
  • immunizations
  • developmental/behavioral screening
  • nutrition assessment and education
  • laboratory tests including blood lead testing
  • anticipatory guidance
  • referral for further diagnostic and treatment services

The EPSDT Care for Kids Informing and Care Coordination Handbook is available online.

Prior Authorization

All providers must follow prior authorization requirements for each MCO. Pharmacy drug claim prior authorizations are handled differently. MCOs must handle prior authorizations within 7 days.

Amerigroup

Amerigroup Medical Management:

UnitedHealthcare

Iowa Medicaid PDL

The Iowa Medicaid Preferred Drug List (PDL) webpages include contact information, policy updates, FAQs, prior authorization forms, and more:

Important Notice

The Iowa Department of Human Services has announced the selection of an additional managed care organization (MCO) to provide services to Iowa’s Medicaid members. The new MCO, Iowa Total Care, will begin providing services for members July 1, 2019. Members will be notified when they are able to select Iowa Total Care as their MCO.

For more information, see the IA Health Link FAQs for Members and FAQs for Providers.

Contact the MCOs

Amerigroup

Amerigroup Iowa, Inc.

Email:
iowamedicaid@amerigroup.com

Phone:
1-800-454-3730

Website:
https://providers.amerigroup.com/ia

UnitedHealthcare

UnitedHealthcare of the River Valley, Inc.

Email:
IowaCommunityNetwork@uhc.com

Phone:
1-888-650-3462

Website:
http://www.uhccommunityplan.com/health-professionals/ia.html

AmeriHealth Caritas

AmeriHealth Caritas Iowa, Inc.

Email:
IowaProviderNetwork@amerihealthcaritas.com

Phone:
1-844-411-0579

Website:
www.amerihealthcaritasia.com/IAProvider

AmeriHealth Caritas Iowa, Inc. withdrew from Iowa's Medicaid managed care program on November 30, 2017. Use this information to contact them regarding services provided through the withdrawal date.

AmeriHealth Caritas Provider Handbook:

  • Section VI: Grievances, Appeals and Fair Hearings

Iowa 1st Five Initiative

Healthy Mental Development

The 1st Five Healthy Mental Development Initiative is a public-private partnership bridging primary care and public health services in Iowa. The 1st Five model supports health providers in the earlier detection of social-emotional and developmental delays and family risk-related factors in children birth to 5 and coordinates referrals, interventions and follow-up.

Visit the 1st Five website to find links to resources for professionals and parents, program materials and videos, and links to related information.

DHS Medicaid Tools

Providers should continue to use the eligibility tools from the Iowa Department of Human Services (DHS) to determine a member's MCO enrollment. Link to Medicaid Tools for Providers on the DHS website.

Managed Care Ombudsman Program

The Managed Care Ombudsman Program (MCOP) help people navigate the managed care system. In addition to its focus on older Iowans, MCOP advocates on behalf of children enrolled in HCBS waiver programs, which include intellectual disability, children's mental health, health and disability, and brain injury waivers.

Visit the MCOP webpage to find links for providers and members, MCOP reports materials, and and information for filing complaints.

Email the MCOP ombudsman: ManagedCareOmbudsman@iowa.gov

Grievances and Appeals

Providers may file claim disputes with the managed care organizations (MCOs). Each of the three MCOs has developed and implemented written policies and procedures for claim disputes. You will find information about their grievances and appeals policies and procedures in their provider handbook or manual. Link to these online:

Amerigroup Provider Handbook:

  • Chapter 14: Grievances and Appeals

UnitedHealthcare Provider Manual:

  • Chapter 4: Grievances, Appeals and State Fair Hearings

Website Accessibility

EPSDT is committed to making all information and materials accessible to everyone.

To increase the font size on pages, hold CTRL and press + (PC) or hold Command and press + (Mac). Please contact us if you need materials in alternate formats.