Manuals, Forms and Resources
Manuals
- Provider Manual (PDF) - Includes information on, but not limited to, program benefits and limitations, prior authorizations, urgent and emergency care, member rights, provider rights for advocating on behalf of members, cultural competence, grievances and appeals, key contacts, Iowa Total Care’s billing guidelines, cost sharing requirements, and policies and procedures for third party liability and other collections. (For information on routine vision services, see the Envolve Vision Office Manual link below.)
- Consumer-Directed Attendant Care (CDAC) User Guide (PDF) - Includes information on CDAC services covered by Iowa Total Care.
- Envolve Vision Office Manual – Includes information on routine vision services. After creating an account, use the Eye Health Manager provider portal to view the office manual, plan specifications, policies and procedures, verify member eligibility, manage claims, check the status of a claim, review past claim submissions, and reprint EOPs.
Forms
*Before filling out the forms below, right-click on the link and choose “Save Link As” to save it to your desktop. This will make sure the file shows the information correctly.
- ABA Checklist (PDF)
- Authorized Representative Designation Form (PDF)
- Educational Material Request Form (PDF) - This form allows providers to request member- and
provider-facing materials. - Notice of Payment Suspension (PDF)
- Notification of Pregnancy (NOP) Form: English (PDF)
- Notification of Pregnancy (NOP) Form: Spanish (PDF)
- PCP Change Form (PDF)
- Pregnancy Support Referral Form (PDF)
- Provider Claim Refund Form (PDF)
- Provider Dispute Form (PDF)
- Provider Formal Administrative Complaint Form (PDF)
- Provider Language Services Complaint Form (PDF)
Visit the Iowa HHS Prior Authorization webpage for the uniform prior authorization forms/guides listed below:
- Outpatient Medicaid Prior Authorization Form, 470-5595 | 470-5595 Resource Guide (Comm. 039)
- Inpatient Medicaid Prior Authorization Form, 470-5594 | 470-5594 Resource Guide (Comm. 038)
- Supplemental Form (470-5619)
Provider Contracting & Credentialing Forms have been moved to the Contracting & Credentialing Forms page.
Provider Resources
- Provider Welcome Reference Guides (PDF)
- Advance Directives (PDF)
- Americans with Disabilities Act (ADA) & Service Animals Quick Reference Guide (PDF)
- Cardiac and Orthopedic PA Code Updates: 11.1.2022 (PDF)
- Childhood Immunization Review: Rotavirus & Influenza (PDF)
- Chlamydia: Increasing Screening & Testing Rates (PDF)
- Chlamydia Screening Educational Information FAQ (PDF)
- Coding Reference Guide (PDF)
- Consent for Sterilization (PDF)
- Diabetic Eye Exam Report (PDF)
- Doula Services (PDF) - Visit our Doula Program page for more information.
- Early Periodic Screening, Diagnosis, and Treatment CAHPS Powerpoint (PDF)
- Envolve Vision Provider Resource (PDF)
- EPSDT Toolkit (PDF)
- Health Literacy & Cultural Competency Flyer (PDF)
- HEDIS FUI for Substance Use Disorder Flyer (PDF)
- HEDIS Pharmacotherapy for Opioid Use Disorder (POD) Flyer (PDF)
- HEDIS Quick Reference Guide (PDF)
- Hospice Provider Guidelines (PDF)
- HPV Vaccination Guide (PDF)
- Language Access Services & Guidelines Quick Reference Guide (PDF)
- Language Access Services Request Form (PDF)
- Language Interpretation Services Poster (PDF)
- Medicaid Preventative Care Fact Sheet (PDF)
- Medication Adherence Flyer (PDF)
- My Health Pays Rewards Information & Codes (PDF)
- Negative Balance Guide (PDF)
- Prior Authorization FAQ (PDF)
- Provider Incentive Flyer (PDF)
- Provider Lead Screening Flyer (PDF)
- Provider Portal Batch Claim Submission (PDF)
- Provider Portal: Recurring Claims Submission (PDF)
- Provider Portal & Registration Login (PDF)
- Provider Portal: Single Claim Submission (PDF)
- Provider Portal: Uploading Documents (PDF)
- Provider Portal: Viewing Claims (PDF)
- Provider Portal: Viewing Prior Authorizations (PDF)
- Provider Respiratory Conditions (PDF)
- Social Determinants of Health (SDOH) Fact Sheet (PDF)
- SDOH: Z Codes Quick Reference Guide (PDF)