Welcome! Join IME, Be a Provider

The Provider Services Unit is responsible for enrolling new providers and maintaining provider records for all Iowa Medicaid provider types.  

Our Enrollment team is excited to hear from you and welcome you aboard Iowa Medicaid.  Enrollment with the Medicaid program is free and easy!

Information for Specific Medicaid Providers

Click here for a list of providers who can enroll to provide the medical services and health services that are included within the scope of the Medicaid program, as well as the principal conditions, restrictions and limits that apply to each. This information is included so all providers may be aware of the medical benefits to which members are entitled.

Important Information for All Providers

I. General Program Policies
II.Member Eligibility

Enrollment Documents

Note: there is no charge to enroll with Iowa Medicaid.

Organizational Provider Application Form 

Instructions

Changes to Ownership & Control Disclosure

Atypical Provider Declaration Form

HCBS Waiver Provider Application Form

Individual CDAC Disclosure

Provider Agreement

W9 IRS Form

To add an individual or sub-part to your organization

Record Check Consent Form

Applications are available via the Internet and paper applications are available upon request.  Any Medicaid enrollment form that has been duplicated or altered in any manner will be automatically denied.

Please Note: Provider numbers are confidential, the Provider Services Unit will NOT release provider numbers or any other provider information to anyone other than the provider.  Provider information will not be mailed to an address other than the provider address listed on the Provider Enrollment Master File. They will not be given to anyone over the phone, and will not be faxed to anyone.  It is the provider's responsibility to notify their biller or corporate office of their correct provider name(s) and provider number(s) to be used in filing Medicaid claims, and also to forward any other pertinent billing information.


It is the provider's responsibility to ensure that their provider records are kept up to date.  The provider must report any changes to the Provider Services Unit.  If the Provider Enrollment Unit is not properly informed of changes the provider number will be made inactive
Each State Medicaid program has different enrollment requirements.  In order to become a Medicaid Provider, providers must have a valid Practice Licensure (for his/her designee's acceptance of an application for enrollment) in order to be accepted into the Medicaid program.
Each provider of services to Iowa Medicaid members must enroll separately


If you have questions or need assistance completing the enrollment forms, contact the Provider Enrollment Unit by e-mail at imeproviderservices@dhs.state.ia.us or call us @ 800-338- 7909 (Option 2) or locally at 515-256-4609
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