Medicaid Tools for Providers

 


Electronic Visit Verification (EVV) Resource Center:
EVV will be used to monitor the delivery and utilization of personal care and home health services in non-traditional settings and will provide verification of the visit with location information and a time stamp. EVV will be used to ensure quality and program integrity (PI) and is a valuable mechanism to ensure that members are receiving the care they need that is outlined in their service plan. This system will help provide real time alerts when a provider is late or misses a medically necessary service included in a member’s service plan.

Medicaid Presumptive Eligibility Portal (MPEP):
The Medicaid Presumptive Eligibility Portal (MPEP) is a self-service portal that is used by an approved qualified entity (QE) for presumptive Medicaid eligibility determinations. More information regarding presumptive eligibility (PE) can be found on the presumptive eligibility webpage.

Electronic Data Interchange Support Services (EDISS):
The Iowa Medicaid Enterprise (IME) is contracted with an electronic vendor, Electronic Data Interchange Support Services (EDISS). This company provides free software for providers to electronically file claims, PC- ACE pro 32, as well as a web-based application "EDISS Connect". The above link explains how TOB allows providers:

  • to access Electronic Remittance Advice (835)
  • to manage their paper work
  • to access real time updates to the electronic system

A wide range of education regarding TOB along with electronic billing is also available on www.edissweb.com.

Eligibility and Verification Information System (ELVS):
The Iowa Medicaid Enterprise (IME) is contracted with an electronic vendor, Electronic Data Interchange Support Services (EDISS). Above is a link to the EDISS Web Portal that is available to providers. This portal is available 24 hours a day, seven days a week and can be used to pick up and drop off batch files and submit real-time requests for Eligibility, Claim Status, Prior Authorizations and Provider Summary.

  • Login ID and password may be obtained through EDI by submitting the following request form to EDI or calling EDI at 1-800-967-7902.
  • Multiple User Access available
The Iowa Medicaid Enterprise (IME) has an electronic phone system that allows providers to verify member eligibility 24 hours a day, seven days a week. By simply entering a provider number and the member state ID, a provider can verify:
  • member eligibility for the current date or past dates of service
  • if the member has a primary insurance
  • if the member is on any type of Managed Care program offered by the IME
  • any remaining spenddown on file
If you do not have the member state ID and feel that the member may be on Medicaid, providers may query data by entering the person's date of birth and Social Security number. This system also allows providers access to their last payment information including date of payment.
 
For queries, call the the ELVS phone line at: 
  • 515-323-9639 (locally in Des Moines)
  • 1-800-338-7752 (toll-free)

Iowa Medicaid Electronic Records System (I-MERS):
Iowa Medicaid Electronic Records System (I-MERS) is a web-based tool that is free-of-charge that allows treating providers electronic access to up-to-date information about all claims submitted to Iowa Medicaid Enterprise (IME) for all current eligible Medicaid members. I-MERS does not include sensitive information on mental health, HIV/AIDS and other information excluded by the state. It is used by treating providers to access critical claim information for medical procedures, prescriptions, and other medical care that eligible Medicaid members have received. I-MERS also assists providers in caring for members, coordinating their care, reducing costly duplicated services and assisting in maintaining high quality care for Medicaid members.

Iowa Medicaid Portal Access (IMPA):
The Iowa Medicaid Enterprise (IME) implemented a provider portal called Iowa Medicaid Portal Access (IMPA) that is managed by the Provider Services unit. IMPA is a web-based tool that allows providers access to multiple different functions that may be needed. Through this tool providers are able to access: