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  • Medicaid Claims and Billing - Health Human Services
    Effective August 1, 2019, Iowa Medicaid and the Managed Care Organizations (MCOs) implemented a mandatory electronic billing requirement for all Medicaid enrolled providers for both Fee-for-Service (FFS) and Managed Care (MC) claims
  • Policies, guidelines and manuals | Wellpoint Iowa, Inc.
    Find information for assessing coverage options, Utilization Management (UM) Guidelines, clinical practice policies and support for delivering benefits to our members
  • INFORMATIONAL LETTER NO. 2473-MC-FFS DATE: June 13, 2023
    EFFECTIVE: July 1, 2023 Effective for dates of service on or after July 1, 2023, Iowa Medicaid will deny reimbursement for Current Procedural Terminology (CPT) code 99211 when appended with modifier 25
  • Provider Claims Billing Manual - Molina Healthcare
    Providers must follow the appropriate State and CMS provider billing guidelines Providers must utilize electronic billing though a clearinghouse or the Availity Essentials portal whenever possible and use current HIPAA compliant ANSI X 12N format (e g , 837I for institutional claims, 837P for professional
  • Medicaid NCCI Policy Manual | CMS
    CMS updates the NCCI Policy Manual for Medicaid Services once a year The NCCI Policy Manual should be used as a general reference tool that explains the rationale for NCCI edits The most current policy manual, effective Jan 01, 2025, was posted on Feb 28, 2025
  • Medicaid Provider Policy Manuals - Health Human Services
    Billing Iowa Medicaid Durable Medical Equipment (New!)
  • Coverage Billing Information for the 2023 Quarterly Code Update
    Iowa Medicaid has reviewed the Q2 2023 Billing Code Update to determine coverage and billing guidelines The Iowa Medicaid coverage and billing information provided in this bulletin is effective April 1, 2023 This bulletin serves as a notice of the following information:
  • Reimbursement policies | Wellpoint Iowa, Inc.
    Providers and facilities are required to use industry standard codes for claim submissions Services should be billed with CPT ® codes, HCPCS codes and or revenue codes The billed code (s) should be fully supported in the medical record and or office notes
  • INFORMATIONAL LETTER NO. 2472-MC-FFS DATE: September 11, 2023
    As announced in IL 2323-MC-FFS-CVD2, the Centers for Medicare and Medicaid Services (CMS) added POS code 10 for telehealth to indicate that a member is receiving telehealth services in their home Iowa Medicaid adopted POS code 10 on April 1, 2022 To clarify, all services delivered via telehealth must be billed with one of the following POS codes:
  • Covered Services, Rates and Payments - Health Human Services
    Please see the most recent update below for Iowa Medicaid Fee-For-Service coverage and billing information Iowa Legislature mandated that Iowa Medicaid no longer provides coverage or payment for elective, non-medically necessary C-section deliveries





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