Department of Human Services Letterhead s5

THOMAS J. VILSACK, GOVERNOR DEPARTMENT OF HUMAN SERVICES SALLY J. PEDERSON, LT. GOVERNOR KEVIN W. CONCANNON, DIRECTOR

June 10, 2005 Informational Letter No. 417

To: All Iowa Medicaid Providers

From: The Iowa Department of Human Services, Iowa Medicaid Enterprise

RE: The Iowa Medicaid Enterprise (IME) – Changes and Enhancements

Effective Date: June 30, 2005 Welcome to the IME!

What is the IME?  The Iowa Medicaid Enterprise (IME) unites DHS Staff and “Best of Breed” contractors into a performance-based model for administration of the Iowa Medicaid Program.  The IME sets a new standard for excellence  An innovative approach to Medicaid designed to fulfill the needs and expectations of all stakeholders  A business-savvy model based on successful MCO/HMO operations  Integrated, single-facility program functions overseen by the state

New IME Provider Services Website www.ime.state.ia.us

 Access to Provider Manuals, Fee Schedules, Forms, and More  Get the Latest and Greatest Medicaid Information  Sign-up for future Provider Trainings  Download Provider training material  Access Provider Enrollment Forms  A Searchable Electronic Provider Directory  Electronic Claims Information and other HIPAA Electronic Transactions  Email Questions and Comments Directly to the IME Provider Services Unit at: [email protected]

On June 30, 2005, a web portal will be available that providers can use to check member eligibility or claim status, or to submit electronic claims transactions. If you wish to use the IME Web Portal, or to submit and receive other HIPAA Transactions such as the 835 Electronic Remittance Advice, call the EDISS office at 1-800-967-7902 (10 am to 4 pm CT) or visit: http://www.noridianmedicare.com/provider/edi/user_docs_iowa_medicaid.html

IOWA MEDICAID ENTERPRISE - 100 ARMY POST ROAD - DES MOINES, IA 50315 Changes In Claims Submission Procedures

 CDAC Providers will only be affected by the address and local telephone number change.  Only HIPAA Compliant Transactions for Electronic Claims can be accepted by the IME. If you submit claims electronically you MUST complete the required forms to enroll with the IME Electronic Data Interchange Support Services (EDISS) prior to June 30, 2005.  No Black and White Claim Copies can be accepted by the IME (you must use the drop out red CMS 1500 and UB 92 Claim Forms, examples attached). Only standard claim forms will be accepted. Self-created claim forms cannot be accepted. Please contact a forms vendor for the appropriate claim forms. For claim form templates to use for your printing purposes visit: http://www.cms.hhs.gov/providers/edi/edi5.asp#Form%20CMS-1500  Do Not Use High-lighters  Do Not Use Red Ink – Black or Blue Ink is acceptable  New Credit and Adjustment Form (available on the IME Website 06/24/05)  Providers who currently receive Medicaid Payments via Electronic Funds Transfer (EFT), your EFT will continue under the IME. If your bank information has changed, complete a new EFT form (found on the IME Website) and submit it to Provider Enrollment at the Correspondence address.

Important IME Transition Dates

 Start sending your paper claims to the IME on 6/24/05. Please use the address below:

MEDICAID CLAIMS P. O. Box 150001 Des Moines, Iowa 50315

 Start sending your Medical/Dental/EPSDT prior authorizations to the IME on 06/30/05. Please use the address below:

MEDICAL PRIOR AUTHORIZATION P.O. Box 36478 Des Moines, Iowa 50315

 Start sending all new cost reports to the IME on 6/20/05*. Please use the address below:

PROVIDER CORRESPONDENCE P. O. Box 36450 Des Moines, Iowa 50315

*Note: If you are amending Waiver, ICF/MR, NF or RCF cost reports, please continue to send those to Ryun, Givens, Wenthe & Co.

Please see the attached pages for the NEW Iowa Medicaid Enterprise Contact Information and Addresses and examples of Standard Claim Forms that will only be accepted by the IME.

Note: the local number for the Eligibility Verification System (ELVS) has changed from information previously distributed. The local number is 515-323-9639. We apologize for any inconvenience that this may have caused you.