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, and key contacts. (For information on routine vision services, see the Envolve Vision Office Manual link below.)
• Provider Billing Manual (PDF) - Includes information on, but not limited to, Iowa Total Care’s billing guidelines, cost sharing requirements, and policies and procedures for third party liability and other collections. 
• 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)
• Critical Incident Report Form (PDF)
• Inpatient Medicaid Prior Authorization Form (PDF)
• Medicaid Supplemental Information Prior Authorization Form (PDF) 
• Notice of Payment Suspension (PDF)
• Notification of Pregnancy (NOP) Form: English (PDF)
• Notification of Pregnancy (NOP) Form: Spanish (PDF)
• Outpatient Medicaid Prior Authorization Form (PDF)
• PCP Change Form (PDF)
• Pregnancy Support Referral Form (PDF)
• Provider Dispute Form (PDF)
• Provider Formal Administrative Complaint Form (PDF)

Provider Contracting & Credentialing Forms have been moved to the Contracting & Credentialing Forms page.

Provider Resources

• Provider Welcome Reference Guides (PDF)
• Advance Directives (PDF)
• Behavioral Health FUH Training (PDF)
• Behavioral Health FUH Tip Sheet (PDF)
• Cardiac and Orthopedic PA Code Updates: 11.1.2022 (PDF)
• Childhood Immunization Review: Rotavirus & Influenza (PDF)
• Chlamydia: Increasing Screening & Testing Rates (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)
• EPSDT Toolkit (PDF)
• Health Literacy & Cultural Competency Flyer (PDF)
• HEDIS Behavioral Health Measures Toolkit: 2022 (PDF)
• HEDIS Quick Reference Guide (PDF)
• Hospice Provider Guidelines (PDF)
• Interpreta: Provider Portal – Daily Quality Care & Risk Gaps Available (PDF).
• Language Access Services and Guidelines Quick Reference Guide (PDF)
• Language Access Services Request Form (PDF)
• Language Interpretation Services Poster (PDF)
• My Health Pays Rewards Information & Codes (PDF)
• Negative Balance Guide (PDF)
• Pregnancy Reference Guide (PDF)
• Prenatal Vitamins (PDF)
• Prior Authorization FAQ (PDF)
• Provider Coding Incentive: Initial Prenatal Visit (PDF)
• Provider Incentive Flyer (PDF)
• Provider Lead Screening Flyer (PDF)
• Provider Portal Batch Claim Submission (PDF)
• Provider Portal: Quality Care & Risk Gaps/Interpreta Demo (PDF)
• Provider Portal: Quality Care & Risk Gaps Daily View – How-To Guide (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)