Individual CDAC Providers
We're glad you are looking to become an Individual CDAC (ICDAC) Provider within the Iowa Total Care network. This ICDAC Provider Checklist will give you an overview of what will be required to become an ICDAC provider.
Please follow the steps below to become part of our network.
If you have questions about enrolling, email rebecca.timmerman@iowatotalcare.com or call her at 515-393-9096.
How To Enroll
Visit the Iowa Medicaid Enterprises (IME) Provider Services website or call 1-800-338-7909 (option 2) or 515-256-4609 (option 2) to request the forms to apply to be an ICDAC provider.
| Form | Complete & Send to IME |
Complete & Send to Iowa Total Care |
|---|---|---|
| 470-2917 HCBS Waiver Provider Application (Sections I & II) |  |
|
| 470-4612 Individual CDAC Disclosure | |
|
| 470-2965 Provider Agreement | |
|
| 470-4227 Record Check Consent | |
|
| 470-4457 Atypical Provider Declaration | |
|
| 470-4202 Electronic Funds Transfer Form | |
|
| W-9 Form (IRS Form W-9) | |
|
| Proof of Age (e.g. copy of drivers license, birth certificate, state-issued ID, passport) | |
Complete all forms and mail to the IME, along with proof of age to:
Iowa Medicaid Enterprise Provider Services
PO Box 36450
Des Moines, IA 50315
Submit a copy of Form 470-2917 HCBS Waiver Provider Application, W-9 Form, and proof of age to Iowa Total Care by mail, fax or email.
Mail: Iowa Total Care
Attn: Network Contracting/Attn: Becky Timmerman
1080 Jordan Creek Parkway, Suite 100S
West Des Moines, IA 50266
Fax: 1-844-966-0769
Contact CareBridge to sign up for Electronic Visit Verification (EVV) training. CareBridge is an electronic system used to complete your ICDAC documentation and to submit claims to Iowa Total Care. Training can be completed prior to being an IME-approved network provider.
Website: CareBridge EVV Training Web
Phone: 1-844-343-3653
Email: IAEVV@CareBridgeHealth.com
When you are approved to be a ICDAC provider by the IME, you will receive an approval letter with your National Provider Identifier (NPI) number. Upon receipt of your approval letter, contact Iowa Total Care to become an activated provider within our system.
Contact: Becky Timmerman
515-393-9096
rebecca.timmerman@iowatotalcare.com
An Iowa Total Care Case Manager will contact you once you are an IME-approved provider to obtain your NPI. The waiver case manager will set up a meeting with you and the member to complete the CDAC Agreement form and the member’s Person Centered Service Plan (PCSP) for:
- service codes
- units allowed per month
- rates
Once services have been approved by Utilization Management, you and the member will be notified by our assigned case manager, and receive a copy of the PCSP and CDAC Agreement.
ICDAC Providers will receive a CareBridge information packet from Iowa Total Care by mail. Upon receipt, you must become a registered user of EVV prior to providing services. Contact CareBridge for your Provider Identification Number (this is different than your NPI). Your Provider ID number will be used to log into CareBridge to check-in and check-out of a visit.
For information or questions about EVV, visit the CareBridge Document Library.
PaySpan allows providers to receive electronic funds directly into your bank account. You will need your NPI and Tax ID Number (TIN) to enroll. To register, call Payspan for a registration code at 1-877-331-7154, option 1 (available Monday through Friday from 7:00 a.m. – 7:00 p.m.).
Visit PaySpan to register.
Important Contact Information
| Carebridge | 1-844-343-3653 |
| IME Provider Services | 1-800-338-7909, option 2 or 515-256-4609, option 2 |
| Iowa Total Care Provider Services | 1-833-404-1061 |
| PaySpan | 1-877-331-7154 |
| Case Manager Map | |
| Provider Relations Territory Map | |
Frequently Asked Questions
Q: Why didn’t I receive a 1099?
Per IRS guidelines, 1099s for payments under $600 in a given year are not required to be sent out. The provider is still required to report this amount even under $600.
Q: I did not receive my 1099, how do I get a reprint?
Please send an email to the Iowa Total Care Provider Relations Department at ProviderRelations@IowaTotalCare.com.
Q: Where can I find a blank W9 form?
Iowa Total Care offers the W9 form (PDF) on our website.
Q: How do I change my address?
- Step 1: Complete a new W9 (PDF) with the current address. Include Individual CDAC’s name, SSN, signature and date signed.
- Step 2: Send completed W9 to ITC_Contracting@IowaTotalCare.com.
- Step 3: Inform IME of address change by phone: 800-338-7909, option 2 or 515-256-4609, option 2.
Q: Why did I not get paid my authorized units?
Please contact Iowa Total Care Provider Services.
Q: Why am I not getting paid correctly per unit?
Please contact your member’s Case Manager.
Q: My claim was denied, what should I do?
Visit our Provider Complaints & Claim Disputes page to review information on what your options are. Those include filing a claim dispute. For additional questions, please contact Iowa Total Care Provider Services.
Q: How do I sign up to track my time and submit my claims?
Your time and claims will be tracked by Electronic Visit Verification (EVV). For more information or questions about EVV, visit the CareBridge Document Library.
Q: How long is my provider credentialing valid?
Contact IME Provider Services by phone: 800-338-7909, option 2 or 515-256-4609, option 2.
Q: How do I read the Explanation of Payments?
Check out our Provider Training for Provider Remittance, Recoupment Guides and Explanation of Payment video. If you have additional questions, please contact Provider Services.
Q: I did not receive an Explanation of Payments, how do I obtain a copy?
If you are receiving paper checks, please contact Provider Services. If you are set up for direct deposit, utilize Payspan. You may also view your Explanation of Payment on the Provider Portal.
Q: How do I get a copy of my Explanation of Payments if I receive paper checks?
Please contact Iowa Total Care Provider Services. You may also view your Explanation of Payment on the Provider Portal.
An Iowa Total Care Case Manager will contact you once you are an IME-approved provider to obtain your NPI. The waiver case manager will set up a meeting with you and the member to complete the CDAC Agreement form and the member’s Person Centered Service Plan (PCSP) for:
- service codes
- units allowed per month
- rates
Once services have been approved by Utilization Management, you and the member will be notified by our assigned case manager, and receive a copy of the PCSP and CDAC Agreement.
Q: I never received my check?
If you have recently moved, you will need to update IME and ITC of your address change, and complete a new W9 to receive your paper checks at your new location. See question, ‘How do I change my address?’
For any additional questions around your paper check, please contact Iowa Total Care Provider Services.
Q: I lost my check, how do I get it reissued?
Please contact Iowa Total Care Provider Services.
Q: How do I obtain my Explanation of Payments?
Log in to Payspan to view your Explanation of Payments. Visit our Payspan page for additional information.
Q: Why is my check not the amount I thought I was getting? Why did you take money back?
Please contact Iowa Total Care Provider Services.