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) at this time. Providers who care for Medicaid members must contract with the MCOs.

Find more information about Iowa Health Link online:

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 assists Title V Child & Adolescent Health agencies and their subcontractors in implementing EPSDT Care for Kids informing and care coordination services. Find more information about Iowa's Title V support for EPSDT Care for Kids on the Iowa Department of Public Health website.

DHS Medicaid Tools

The Iowa Department of Human Services (DHS) make a variety of tools available to providers to help determine member eligibility for services, and support the verification process, data interchange, and more.

Visit the DHS website to find Medicaid Tools for Providers.

Prior Authorization

All providers must follow prior authorization requirements for each MCO. MCOs are required to handle prior authorizations within 7 days. Prior authorizations for pharmacy benefits are handled differently.

Amerigroup Iowa, Inc.

Iowa Total Care

Iowa Medicaid PDL

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

Grievance 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 Manual:

Iowa Total Care Provider Manual:

Ombudsman Program for Managed Care

The Managed Care Ombudsman Program (MCOP) helps 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.

Contact the MCOs

Amerigroup

Iowa Total Care

Provider Services Hours: Monday through Friday, 7:30 a.m. - 6:00 p.m. Central Time

Website Accessibility

Iowa EPSDT is committed to making our information and materials accessible to everyone.

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