Electronic Billing Tips and FAQ

Effective August 1, 2019, the Iowa Medicaid Enterprise (IME) 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 claims. This requirement was implemented for Medicaid enrolled dental providers effective February 1, 2020.

This requirement excludes Individual Consumer Directed Attendant Care (CDAC) providers.

Details of this requirement were announced in Informational Letter 2003-MC-FFS and Informational Letter 2022-MC-FFS-D

 

FFS Claims

What is the electronic billing requirement? 

Effective August 1, 2019, Iowa Medicaid providers are required to process claims electronically through the IME and MCOs. Please see below for additional information regarding how to bill electronically. The mandatory electronic billing requirement also applies to recoupments and adjustments for FFS. Paper forms 470-0040 and 470-4987 are not accepted as of August 1, 2019.

Providers billing for FFS claims use the Iowa Medicaid Portal Access (IMPA) system for submitting supporting documents only.

 

How do I submit claims electronically? 

The IME offers the following options for providers to consider for electronic billing:

  • ABILITY PC-ACE Pro: This software is available to all providers through the IME for billing FFS claims. Contact the IME at the number below for additional information. There is no cost for FFS member claims billed through ABILITY PC-ACE Pro.

  • MCO portals: Each MCO has an online portal for claim submission management. Contact the MCOs at the numbers listed below for additional information.

  • Electronic Data Interchange (EDI) Clearinghouse Options: EDI Clearing House options are available that can be used to bill both FFS and MCO claims.

 

How do I submit supporting documents to the IME?

Providers billing for FFS claims use the IMPA system for submitting supporting documents.

Providers only need to submit supporting documents when such documents are necessary to process a claim. If supporting documents are necessary, providers must upload the documents to IMPA within seven business days of submitting the medical claim.

Once documents are uploaded from IMPA they remain on file. There is no need to upload documents if the claim is denying for something other than documentation. 

 

How do I get access to IMPA? 

IMPA access will be needed for anyone billing claims to the IME. If there are multiple billers wishing to upload documents independently, each biller must have their own IMPA account.

  1. Information about creating an IMPA account and requesting access to upload documents can be found in Informational Letter 2003-MC-FFS.

  2. Once an IMPA account has been created, providers must request access to upload documents to IMPA.

 

What can I submit in IMPA? 

Supporting documents for FFS claims

 

What documents are not to be submitted in IMPA? 

  • Paper claims
  • Provider inquiries
  • Adjustment forms
  • Recoupment forms

 

How do I submit a document in IMPA? 

  1. As of August 1, 2019, providers who have been granted access to upload documents will see an “Upload File” option under the “File” menu on the top left corner within IMPA.

  2. After clicking “Upload File”, providers choose “Electronic Billing Attachments” under the second menu; Do not use “Documents to IME” under the “Upload File” menu to attach documents to an electronic FFS claim. Do not use form number 470-5403 Medicaid Member Documentation Upload Cover Sheet with documents for electronic billing.

  3. “Electronic Billing Attachments” section:

    • In the “Document Types” drop down menu, choose “Claim Attachment”

    • Enter a 16-digit Attachment Control Number (ACN) with the following format:

      1. Format should be member ID number with date of service.

      2. EXAMPLE: If the member ID number is 1234567A and the date of service was August 1, 2019, the ACN would be 1234567A08012019

      3. Some providers have been reporting errors showing "Duplicate file name (ACN) for this document type" on IMPA when trying to upload documents. After the provider puts in regular ACN (1234567AMMDDYYYY), the "duplicate" documentation would need to have an underscore and the number 2 at the end (1234567AMMDDYYYY_2). If there is already a 2 being used, then 3 can be used (and so on...). 

Screen shots of the step-by-step process once you have reached the “Electronic Billing Attachments” section can be found in the Program Updates slide presentation on the DHS website.

 

How do you know which documents are attached to which claims? What is an ACN?

When uploading documentation to IMPA, providers must enter a 16-digit Attachment Control Number (ACN) and their 10-digit National Provider Identifier (NPI) number.

Enter a 16-digit ACN with the following format:

  • EXAMPLE: If the member ID number is 1234567A and the date of service was August 1, 2019, the ACN would be 1234567A08012019

The ACN must also be on the electronic claim so that the claim form and supporting documentation can be matched by the IME when reviewing additional documentation.

 

Where do I put the ACN on my claim? 

  • If using ABILITY PC-ACE Pro software:
    • The ACN box is located on the Institutional claim on the Extended General tab. Enter the ACN number in the box marked “Attachment Control Number‟.
    • If using the Professional claim use the EXT Pat/Gen (2) tab. Enter the ACN number in the box marked “Attachment Control Number‟.
  • If using the 837I or 837P
    • The ACN field is loop 2300 segment PWK05-06.

If you are not able to locate the field please contact your software vendor for assistance with where you may note the ACN on the claim form.

 

When should I submit a provider inquiry?

Provider Inquiry Form 470-3744 may not be submitted for the purpose of attaching documentation.

Supporting documents needed by the IME to process a claim must be uploaded to IMPA. Provider inquiries will still be accepted on paper as of August 1, 2019, but only for appropriate requests:

  • Requesting Medical Services/policy review of Healthcare Common Procedure Coding System (HCPCS)
  • Requesting Medical Services/policy review of fee schedule for HCPCS code
  • Disputing denial of a previously reviewed claim
  • May not be submitted for the purpose of attaching documentation
    • No claim in system with documentation
    • Letter to provider (inquiry will not be processed)

For adjustments and provider inquiries with Amerigroup, the mandatory electronic requirement applies. Overpayment notifications will be accepted on the designated paper forms at the Amerigroup website noted below.

 

How do I submit electronic adjustment requests?

An adjustment is a request for Medicaid to make a change to a previously paid claim.

  • On the 837I/837P enter the REF01 value “F8” in the 2300 REF segment with the Payer Claim Internal Control Number, which is the 17 digit Medicaid TCN number of the claim that needs adjusted.
  • The frequency code of “7” must be entered in the 2300 Loop CLM Segment.
  • It is important to include all charges that need to be processed, not just the line that needs to be corrected; if previously paid lines are not submitted on the adjustment request, they will be recouped from the original request but not repaid on the adjustment, likely resulting in an unintentional credit balance.

 

How do I submit electronic recoupment requests? 

A recoupment is a request for Medicaid to take back the entire original claim payment.

  • On the 837I.837P, enter the REF01 value "F8" in the 2300 REF segment with the Payer Claim Internal Control Number, which is the 17 digit Medicaid TCN number of the claim that needs to be recouped.
  • The frequency code of "8" must be entered in the 2300 Loop CLM Segment.

 

Have more questions not covered here? 

Please contact the IME Provider Services Unit at 1-800-338-7909, or email at IMEProviderServices@dhs.state.ia.us.

 

 

MCO Claims

Find more information about submitting electronic claims to the MCOs:

Amerigroup Iowa

Iowa Total Care