Tools, Training, and Initiatives
Electronic Data Interchange Support Services (EDISS):
The Iowa Medicaid Enterprise (IME) is contracted with an electronic vendor, Electronic Data Interchange Support Services (EDISS). This company provides free software for providers to electronically file claims, PC- ACE pro 32, as well as a web-based application Total OnBoarding (TOB). The above link explains how TOB allows providers:
A wide range of education regarding TOB along with electronic billing is also available on www.edissweb.com.
- to access Electronic Remittance Advice (835)
- to manage their paper work
- to access real time updates to the electronic system
Eligibility and Verification Information System (ELVS):
The Iowa Medicaid Enterprise (IME) has an electronic phone system that allows providers to verify member eligibility 24 hours a day, seven days a week. By simply entering a provider number and the member state ID, a provider can verify:
If you do not have the member state ID and feel that the member may be on Medicaid providers may query data by entering the person's date of birth and Social Security number. This system also allows providers access to their last payment information including date of payment.
- member eligibility for the current date or past dates of service
- if the member has a primary insurance
- if the member is on any type of Managed Care program offered by the IME
- any remaining spenddown on file
Iowa Medicaid Electronic Records System (I-MERS):
Iowa Medicaid Electronic Records System (I-MERS) is a web-based tool that is free-of-charge that allows treating providers electronic access to up-to-date information about all claims submitted to Iowa Medicaid Enterprise (IME) for all current eligible Medicaid members. I-MERS does not include sensitive information on mental health, HIV/AIDS and other information excluded by the state. It is used by treating providers to access critical claim information for medical procedures, prescriptions, and other medical care that eligible Medicaid members have received. I-MERS also assists providers in caring for members, coordinating their care, reducing costly duplicated services and assisting in maintaining high quality care for Medicaid members.
Iowa Medicaid Portal Access (IMPA):
The Iowa Medicaid Enterprise (IME) implemented a new provider portal called Iowa Medicaid Portal Access (IMPA) that is managed by the Provider Services unit. IMPA is a web-based tool that allows providers access to multiple different functions that may be needed. Through this tool providers are able to access:
Training Sessions 2013:
The Iowa Medicaid Enterprise (IME) holds a variety of training sessions throughout the year. This section of the website outlines these training sessions and provides relevant information such as requirements for participation, schedules, locations, dates and times, and more.
Annual Providers Training 2013
The IME invites all Iowa Medicaid providers to the Annual Provider Training for 2013. Based on the success of previous years and in continuing our goal of reaching out to all providers, the IME is pleased to offer sessions in different communities throughout the state to greatly assist providers in their understanding of the programs.
Independent Support Broker (ISB) Training 2013
These training sessions are for individuals interested in becoming Independent Support Brokers (ISB) through IMEs Consumer Choices Option (CCO) program. You must have internet and email access, be able to complete all training requirements, and pass a background check in order to participate in the ISB Training.
Archived Provider Training Information Materials
The Provider Services Outreach Team is dedicated to promoting your success in all aspects of Medicaid billing, guidelines and other critical areas by raising your awareness of the Iowa Medicaid Enterprise (IME) systems, operations and requirements. This link will lead you to a section of the IME website that will provide archived training information materials from previous years.
On June 1, 2011, the Iowa Medicaid Enterprise (IME) notified all Medicaid providers billing electronically that beginning January 1, 2012, all electronic claims must be in the 5010 HIPPA format. The Centers for Medicare and Medicaid Services (CMS) adopted version 5010 to replace the current version of the X12 standard that covered entities ( e.g. health plans, health care clearinghouses, and certain health care providers) must use when conducting electronic transactions. CMS has currently extended the deadline to June 30, 2012. For more information on how to transition and what changes will occur please visit the above link.
On January 16, 2009, the U.S. Department of Health and Human Services (HHS) released the final rule mandating that everyone covered by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) must implement ICD-10 code sets for medical coding on October 1, 2013. On August 24, 2012, the HHS announced that it will delay the ICD-10 compliance date by one year to October 1, 2014. The change in the compliance date for ICD-10 gives providers and other covered entities more time to prepare and fully test their systems to ensure a smooth and coordinated transition to these new code sets.
The Iowa Medicaid Enterprise's (IME) progress toward implementation of the ICD-10 code sets is continuing. The IME continues to prepare for the implementation of ICD-10 by reviewing policy and preparing for updates to medical coverage, rules, operational procedures, and technical systems and intends to conduct external end-to-end testing with providers between October 2013 and October 2014. The IME urges providers to continue forward with their ICD-10 projects. It remains the IMEs goal to work with any impacted organizations doing business with the IME. The Centers for Medicare and Medicaid Services (CMS) offers valuable training materials and information to review on the ICD 10 transition. These can be found by following this link: http://www.cms.gov/Medicare/Coding/ICD10
Heath Information Technology:
Iowa's Medicaid Electronics Health Records (EHR) Incentive Program is playing an important role in establishing critical health information technology designed to reduce costs, improve care, and advance coordination across the healthcare platform. This focused effort is leading to better coordination, quality of care, and fostering healthier lives in Iowa. Eligible professionals and hospitals can apply for the EHR via the Provider Incentive Payment Program (PIPP) system at http://www.imeincentives.com/.
IowaCare for Providers:
IowaCare is limited health care program that covers low-income adults ages 19-64 who would not normally quality for Medicaid. Almost all of these individuals are single or childless couples. IowaCare covers people with incomes up to 200% federal poverty level ($29,420 for a 2 person household). IowaCare services are accessed at federally qualified health care centers across the state, Broadlawns Medical Center and the University of Iowa Hospitals and Clinics. Care is based on the county where you live. Major covered services include inpatient and outpatient hospital, physician and preventive physicals. Services do not include pharmaceuticals, with the exception of those needed during and immediately following hospital stays.
Iowa Medicaid Care Management Programs:
The Iowa Medicaid Care Management consists of Care Management, Disease Management, Maternity, and Lock-In. The common themes across these programs are to provider a high level of care coordination to high utilization high risk Medicaid members. The goals of the programs are to support the provider's plan of care and to coordinate services deemed necessary. Medicaid members receiving the best possible health outcomes from high quality health care.
Iowa Medicaid Pharmaceutical Care Management:
Iowa Medicaid Pharmaceutical Care Management (PCM) is an Iowa Medicaid service provided by physicians and pharmacists working together to closely manage the total medication regimens of their most complex patients. The services are provided to Medicaid members who are identified as being at high risk for medication-related problems. The innovative care delivered through this program is based on a model of care known to improve medication safety in hospital and clinic settings where pharmacists and physicians practice under the same roof and have access to patient care records.