Questions in completing this application: Iowa Medicaid Enterprise Provider Services Unit at (800) 338-7909 or (515) 256-4609.
How to Enroll as an Iowa Medicaid Provider:
Required Documents for Enrolling as an Iowa Medicaid Provider:
If your Tax ID is already active and enrolled with the Iowa Medicaid Enterprise (IME) and you need to add a sub-part or an individual, please complete "Section B" of the Iowa Medicaid Universal Provider Enrollment Application (Form # 470-0254) shown above.
How to Enroll as an Ordering/Referring Provider:
Before Iowa Medicaid can reimburse for services or medical supplies resulting from a practitioner's order, prescription, or referral, the Affordable Care Act requires that the practitioner be enrolled in Medicaid. To address this new requirement and to encourage non-enrolled practitioners to enroll in the IME, a simplified application for practitioners who only order, prescribe, and refer Iowa Medicaid members for services or supplies is available. The Ordering/Referring Provider Application, 470-5111, is available at the link below along with the other necessary documents to complete enrollment.
Providers already enrolled as Iowa Medicaid providers do not need to do anything new.
Practitioners not otherwise enrolled as Iowa Medicaid providers may enroll as ordering/referring providers. This new ordering/referring provider type is appropriate for practitioners who:
- May occasionally see an individual who is an Iowa Medicaid member who needs additional services or supplies that will be covered by the Medicaid program; and
- Do not want to be enrolled as another Iowa Medicaid provider type; and
- Do not plan to submit claims to the IME for payment of services rendered.
Questions in completing this application may be directed to Iowa Medicaid Enterprise Provider Enrollment Unit at (800) 338-7909 (option 2) or (515) 256-4609 (option 2).
How to Enroll as a Qualified Medicare Beneficiary (QMB) Provider:
IMPORTANT NOTICE: The IME is now accepting applications for Medicare providers to enroll exclusively for coordination of benefits. Qualified Medicare Beneficiary (QMB) members have coverage through Iowa Medicaid for the cost of Medicare premiums, deductibles and coinsurance that Medicare beneficiaries usually pay.
Providers that are interested in enrolling under this option will receive coordination of benefits payment from the IME but will not be enrolled for direct claim submission. Please complete and return this Medicare Beneficiaries (QMB) Provider Enrollment Application for each individual professional and institutional category that is part of this business and subject to the Iowa Medicaid provider agreement.
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