Process Improvement Working Group Materials


The Iowa Medicaid Enterprise (IME) and the Managed Care Organizations (MCOs) - UnitedHealthcare (UHC) and Amerigroup (AGP) - have provided various documents, flow charts and information to the Process Improvement Working Group. This information can be found here.

Group 1, Issue 30: Timely Filing 
No changes will be made to the MCOs' 180-day submission standard at this time. 

Group 1, Issue 31: Rates

IME Fee-For-Service Rate Transmittal to Managed Care Organization Process 
MCO Rate Update Process

Group 1, Issue 31: Provider Training 
IME Annual Provider Training Flow Chart

Group 1, Issue 34: Recoupments and Reprocessing of Claims
IME cannot consider extending the timeframe beyond 60 days per federal regulations.

 

Group 1, Issue 36: Appeals, Utilization Management, and Claims Dispute Processes
MCO Inpatient Utilization Management Process 
MCO Appeals & Grievance Process 
MCO Prior Authorization Process 
MCO Claim Reconsideration & Dispute Process

Group 1, Issue 36: MCO Medical and Pharmacy Prior Authorizations
MCO Medical and Pharmacy Prior Authorizations

Group 2, Issue 1: Non-Emergency Medical Transportation (NEMT) 
UHC Narrative: NEMT
AGP Narrative: NEMT

Group 2, Issue 2: Member Authorization Form to Allow Provider to Appeal on Member's Behalf 
Universal Form for IME and MCOs

Group 3: Data/Outcome Resources
NQF
NCI
HEDIS 2019 Measures
CMS Measures for MLTSS
CAHPS Health Plan Survey
MDS 3.0 Quality Measures

Group 3, Issue 57: MCO Joint Treatment Planning
UHC Narrative: Joint Treatment Planning

Group 3, Issue 60: Accountable Care Organizations
UHC Narrative: Accountable Care Organizations

Group 3, Issue 62: Contact Information for Case Managers
UHC

Group 3, Issue 64: Case Management for Long Term Support Services (LTSS)
UHC Key Contact Information for Iowa Managers of Case Managers
AGP LTSS Management Regions

 

Group 3, Issue 94: HIPAA Referral System
Because the MCOs, including the dental wellness program are not able to establish business associates agreements with each other, federal law prohibits this.
 

Group 4, Issue 86: Speciality Providers

UHC Narrative: Speciality Providers

UHC HCBS & ICF/ID Credentialing and Contracting Workflow

AGP Credentialing Workflow

AGP Step-by-Step Credentialing Process

AGP Speciality Providers List
 

Group 4, Issue 87: MCO Credentialing Training

UHC Narrative: General Training

MCO Standard Credentialing and Contracting Workflow

UHC HCBS & ICF/ID Credentialing and Contracting Workflow
 

Group 4, Issue 88: MCO Credentialing Training

IME Provider Enrollment Process Flow Chart

IME Provider Enrollment Delays

MCO Standard Credentialing and Contracting Workflow