470-2965 Iowa Medicaid Provider Agreement General Terms - dhs iowa-2026

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The document outlines the Iowa Medicaid Provider Agreement, detailing the responsibilities and obligations of providers participating in the Iowa Medicaid Program. It emphasizes compliance with federal and state laws, including anti-discrimination statutes, confidentiality regulations, and requirements for reporting ownership and control information. The agreement also covers reimbursement procedures, record-keeping requirements, termination conditions, and the relationship between the provider and the Department of Human Services. Additionally, it includes provisions related to business associates handling protected health information.

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Click ‘Get Form’ to open it in the editor.
Begin by entering your Provider Business Entity Name and Federal Tax ID or Social Security Number in the designated fields at the top of the form.
Proceed to Section 1, where you will need to review and acknowledge compliance with various legal standards. Ensure you understand each requirement before signing.
In Section 2, provide details regarding reimbursement agreements. Fill out any necessary information about other health coverage for members.
Complete Section 3 by noting any required notices or changes that must be reported to the Department within specified timeframes.
In Section 4, ensure that you maintain accurate records as outlined. This includes financial and service records for a minimum of five years.
Finally, sign and date the document in the designated area at the end of the form, ensuring all information is accurate before submission.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is a Medicaid contract?

Medicaid managed care provides for the delivery of Medicaid health benefits and additional services through contracted arrangements between state Medicaid agencies and managed care organizations (MCOs) that accept a set per member per month (capitation) payment for these services.

What is the purpose of the provider agreement?

A provider agreement is a legal document that establishes a relationship between a service provider and the person or business who hired them.

What is a Medicaid provider agreement?

Medicaid Provider Agreement or provider agreement means a contract between the agency and a provider for the provision of services or goods, or both, to Medicaid recipients pursuant to Medicaid.

Who are the Medicaid providers in Iowa?

Provider Services for Managed Care Organizations (MCOs) Iowa Total Care. Phone: 1-833-404-1061. Email: providerrelations@iowatotalcare.com. Molina Healthcare of Iowa, Inc. Email: IAProviderRelations@MolinaHealthcare.com. Phone: 1-844-236-1464. Wellpoint Iowa. Phone: 1-833-731-2143. Email: ProviderSolutionsIA@wellpoint.com.

What is a provider agreement for Medicare?

Medicare Provider Agreement means an agreement entered into between a health care facility, supplier or physician and CMS or any federal or state agency or other entity administering Medicare in such state, or other grant of authority by CMS or any federal or state agency or other entity administering Medicare in such

iowa dhs forms

form 470-5112 Iowa Medicaid Provider portal form 470-4202 iowa medicaid form 470-4202 Iowa Medicaid Provider types Iowa Medicaid Provider Enrollment form 470-5112, designated contact person Iowa Medicaid Provider tax

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How do providers get paid from Medicaid?

Under managed care, the state pays a fee to a managed care plan for each person enrolled in the plan. In turn, the plan pays providers for all of the Medicaid services a beneficiary may require that are included in the plans contract with the state.