Medicaid Managed Care

EPSDT Care for Kids

EPSDT Care for Kids is Iowa's Early and Periodic, Screening, Diagnosis and Treatment program for children who are enrolled in Medicaid. EPSDT Care for Kids services are free to children enrolled in Medicaid. EPSDT services include:

• health history
• physical exam
• growth and development assessment
• vision and hearing screening
• dental screening and education
• immunizations
• developmental/behavioral screening
• nutrition assessment and education
• laboratory tests including blood lead testing
• anticipatory guidance
• referral for further diagnostic and treatment services

The EPSDT Care for Kids Informing and Care Coordination Handbook provides support for Title V Child & Adolescent Health agencies and their subcontractors to implement EPSDT informing and care coordination services.

Iowa HHS Medicaid Resources and Tools

The Iowa Department of Health and Human Services has a variety of tools to help providers determine member eligibility for services, and support the verification process, data interchange, and more. To understand how the Medicaid program operates in Iowa, download the Provider Reference Guide.

Visit the Medicaid Provider Services webpage and scroll down to find contact information, and link to resources and related tools.

Iowa's MCOs

Iowa Health Link provides health coverage through a Managed Care Organization (MCO) to children and youth who are eligible for EPSDT benefits. Iowa's three MCOs have a large network of health care providers across the state.

Iowa Total Care

• Provider Manual

Molina Healthcare of Iowa

• Provider Materials

Wellpoint Iowa, Inc.

• Policies, guidelines and manuals

Prior Authorization

All providers must follow prior authorization requirements for each MCO. MCOs are required to handle prior authorizations within 7 days. Prior authorizations for pharmacy benefits are handled differently.

Iowa Total Care

• Phone: 1-833-404-1061; choose Option #3, and then Option #5.
• Medicaid Prior Authorization
• Pharmacy

Molina Healthcare of Iowa

• Phone: 1-844-236-1464
• Iowa Providers - Click on Prior Authorization "Code LookUp Tool"
• Provider Resources and Forms

Wellpoint Iowa, Inc.

• Phone: 1-800-454-3730
• Wellpoint prior authorization requirements

Iowa Medicaid PDL

The Iowa Medicaid Preferred Drug List (PDL) webpages include contact information, policy updates, FAQs, prior authorization forms, and more:

• Preferred Drug List (PDL)

Grievance and Appeals

Providers may file claim disputes with the managed care organizations (MCOs). Each of the three MCOs has developed and implemented written policies and procedures for claim disputes. Follow these links to find information about policies and procedures for grievances and appeals:

Iowa Total Care

• Provider Billing Manual
• Provider Complaints and Claim Disputes

Molina Healthcare of Iowa

• Submitting Claims & Appeals
• Provider Appeal Dispute Form

Wellpoint Iowa, Inc.

• Claims Overview
• Claims submissions and disputes

Contact the MCOs

Iowa HHS maintains information about the three Managed Care Organizations (MCOs) that currently serve Iowa's Medicaid Members. Learn more about Iowa's MCOs.

Iowa Total Care

• Phone: 1-833-404-1061
• Website: Iowa Total Care for Providers

Molina Healthcare of Iowa

• Phone: 1-844-236-1464
• Email: IAProviderRelations@MolinaHealthcare.com
• Website: Molina Healthcare of Iowa Providers

Wellpoint Iowa, Inc.

• Phone: 1-833-731-2143
• Website: Wellpoint Iowa Providers Contact Us

Ombudsman Program for Managed Care

The Managed Care Ombudsman Program (MCOP) helps people navigate the managed care system. In addition to its focus on older Iowans, MCOP advocates on behalf of children and youth. Find reports, materials, and information for filing complaints on the MCOP webpage.