Provider Enrollment

Provider Enrollment:

Providers wanting to enroll as an Iowa Medicaid provider must submit an enrollment application to the Iowa Medicaid Enterprise (IME) Provider Enrollment Unit. No payment will be made to a provider for services prior to the effective date of the department's approval of an application. The enrollment application is used to screen and verify that provider has met federal regulations and state requirements prior to enrollment.

Waiver Enrollment:

The following page provides information for both Individual Consumer Directed Attendant Care (CDAC) providers and Agency / Business waiver providers.

Health Home Enrollment:

A Health Home enables providers to offer additional services for members with specific chronic conditions. Providers must meet standards outlined by the state and seek patient centered medical home (PCMH) recognition within 12 months of enrolling in the program. To facilitate a team-based, community focused approach, providers participating as a Health Home must connect to the Iowa Health Information Network (IHIN).

Program Integrity Provisions of the Affordable Care Act (ACA) for Provider Enrollment and Screening:

To improve the program integrity of the Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP) programs, the Patient Protection and Affordable Care Act (ACA) requires these programs to screen and enroll all providers associated with the program. For the IME, the new requirements are more extensive than the previous screening procedures and include enrolling providers who were not previously required to enroll in Medicaid. The changes will allow Medicaid programs to more effectively monitor and restrict those individuals or entities who purposely defraud and abuse the Medicaid system.

Provider Quality Management Self-Assessment

The Home and Community Based Services (HCBS) Provider Quality Management Self-Assessment will be required of all providers enrolled for the services identified, regardless of whether those services are currently being provided. All sections of the self-assessment must be completed as requested (Sections A, B, C, D, E, and F) and submitted as a single document by the deadline indicated each year.

Excluded Individuals and Entities:

A searchable, online database for all individuals and entities excluded from participation with Iowa Medicaid. This is a national list maintained by the US Department of Health and Human Services, Office of the Inspector General and is regularly updated.

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