Medicaid Managed Care

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. EPSDT 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. The State Library of Iowa maintains this EPSDT Care for Kids handbook at Iowa Publications Online.

Iowa HHS Medicaid Tools

The Iowa Department of Health and Human Services (Iowa HHS) makes 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 Provider-Specific Resources webpage and scroll down 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.

• Phone: 1-800-454-3730
• Amerigroup Prior Authorization

Iowa Total Care

• Phone: 1-833-404-1061; choose Option #3, and then Option #5.
• Medicaid Prior Authorization
• Pharmacy

Molina Healthcare of Iowa

• https://www.molinahealthcare.com/providers/ia/medicaid/home.aspx
• Scroll down and click on Prior Authorization "Code LookUp Tool"
• Link to more Authorization/Utilization Management resources

Iowa Medicaid PDL

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

• Preferred Drug List (PDL)

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 Providers:

• Amerigroup Iowa Provider Home
• Claims Submissions and Disputes

Iowa Total Care Provider Manual:

• Provider Manual
• Provider Complaints and Claim Disputes

Molina Healthcare of Iowa

• Provider Appeal Dispute Form
• Fax form to Molina Healthcare of Iowa Appeals and Grievances at 1-855-275-3082.

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

• Phone: 1-800-454-3730
• Email: iowamedicaid@amerigroup.com
• Website: https://providers.amerigroup.com/ia

Iowa Total Care

• Phone: 1-833-404-1061
• Website: https://www.iowatotalcare.co/providers

Molina Healthcare of Iowa

• Phone: 1-844-236-1464
• Email: IAProviderRelations@MolinaHealthcare.com
• Website: https://www.molinahealthcare.com/providers/ia/medicaid/home.aspx

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