Welcome to the Iowa Medicaid Enterprise (IME) Website for Providers

The Iowa Medicaid Enterprise (IME) is privileged to work with talented and qualified professional health care providers in the State of Iowa. The IME works with in collaboration with our partners in health care industry in order to provide quality and most cost-effective access to health care for Iowa Medicaid members. Your efforts and commitment have resulted in a significant increase in the number of Iowa families who have access to health care. Please consider joining our provider network in caring for Iowa's most vulnerable population.

Providers Services Contact Information:
800-338-7909 Toll Free
515-256-4609 (Des Moines area)
515-725-1155 (Fax)

Provider Services
P.O. Box 36450
Des Moines, IA 50315

News and Announcements

  • Medicaid Presumptive Eligibility Portal (MPEP): This new presumptive provider self-service web portal for use by Qualified Entities (QEs) to make presumptive eligibility determinations is now available. For a Presumptive Provider (PP) to enroll and be certified as a Qualified Entity (QE), the PP must go through an enrollment and certification process. Please readInformational Letter 1333to know more about this important process. Uponcertification as a QE, the PP will be able to log into and utilize the newMedicaid Presumptive Eligibility Portal (MPEP)to make presumptive eligibility determinations.

  • Referring or Prescribing Providers:Beginning January 6, 2014 claims submitted to the IME with a referral or prescriber identifier will be denied if submitted with an NPI that is not enrolled and active with the Iowa Medicaid program. Please refer to Informational Letter 1330 for more information. To access the list of active ordering and referring providers, please click HERE. This file will be updated regularly.

  • Iowa Wellness Plan Patient Manager Agreement: Beginning January 1, 2014, the Iowa Wellness Plan will employ new coverage options for adults ages 19 through 64 with income up to and including 100 percent of the Federal Poverty Level (FPL). The Iowa Wellness Plan is an option that will be available in all counties. Each county will require a network of patient managers to monitor and coordinate health care services. The Patient Manager will be the main point of access for healthcare with the members receiving referrals for specialty services within the full Medicaid provider network. Providers that wish to become a patient manager must fill out and submit theIowa Wellness Plan Patient Manager Agreement. Send the filled out electronic agreement form online by clicking Submit Form.

  • Iowa Medicaid Sanction List: To access the Iowa Medicaid Sanction List, please click HERE. This file will be updated regularly by the Iowa Medicaid Program Integrity.

  • Home Health Services Low Utilization Payment Adjustment (LUPA): Pursuant to recent Iowa Legislative action (Iowa Code Section 249A.4, and 2013 Iowa Acts, Senate File 446, section 29), the Low Utilization Payment Adjustment (LUPA) methodology became effective July 1, 2013. The services of the Home Health Services program that will be reimbursed by the LUPA wage index adjusted rate methodology include: Skilled Nursing, Home Health Aide, Physical Therapy, Occupational Therapy, Speech Therapy, and Medical Social Services. For more information, please read Informational Letter 1256. Access theLUPA Rate Sheetto see the providers Home Health Services. Read some of thequestions and answersthat have been submitted regarding this Legislative action.

  • Quality Improvement Projects: The Adult Quality Measure Grant Program is funded by CMS and is designed to support state Medicaid agencies in developing staff capacity to collect, report, and analyze data on the Initial Core Set of Health Care Quality Measures for Adults Enrolled in Medicaid. In line with the goals of this program, the Iowa Medicaid Enterprise (IME) has selected two Quality Improvement Projects (QIPs). The first focuses on reducing short-term complications of diabetes. The second focuses on Medicaid enrolled adult patients that have been identified as high-risk for an asthma-related hospital admission and/or emergency department (ED) visit. The goal of the QIPs is to reduce admission rates by 10 percent by December 20, 2014. Please read Informational Letters1264and1301detailing the QIPs. For additional information, please read the FAQ for theDiabetes QIPand theAsthma QIP

  • OIG Special Advisory Bulletin: On May 8, 2013 the Office of Inspector General (OIG) issued an updated special advisory bulletin on the Effect of Exclusion from Participation in Federal Health Care Programs. The bulletin provides background and responds directly to frequently asked questions regarding exclusions and the resulting actions.
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