470 2486-2026

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496 votes

The document is a claim form for targeted medical care provided by the Iowa Department of Human Services. It includes sections for member and provider information, details about services rendered, and certification statements regarding the accuracy and necessity of the claims. The form emphasizes compliance with Medicaid program requirements and provides instructions for submission.

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Click ‘Get Form’ to open the 470 2486 in the editor.
Begin by entering the MEMBER INFORMATION. Fill in the STATE ID and MEMBER’S NAME (LAST, FIRST, MI) accurately.
Next, provide PROVIDER INFORMATION. Enter the NPI PROVIDER NUMBER and complete the PROVIDER ADDRESS fields including STREET, CITY, STATE, and ZIP CODE.
Indicate if there is OTHER INSURANCE by selecting YES or NO. If applicable, provide details about any OTHER INSURANCE DENIED.
In the SERVICES section, list each service provided along with its PROCEDURE CODE, PLACE OF SERVICE, FIRST DATE, LAST DATE, UNITS, and TOTAL LINE CHARGE.
Complete CLIENT PARTICIPATION AMOUNT and THIRD PARTY PAYMENT sections as necessary.
Finally, ensure that both PROVIDER SIGNATURE and MEMBER/GUARDIAN SIGNATURE are included along with their respective dates.

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Who are Iowa Medicaid providers?

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. Medicaid Provider Services | Health Human Services Iowa.gov Medicaid Iowa.gov Medicaid

Does Iowa Medicaid accept paper claims?

Iowa Medicaid and the Managed Care Organizations (MCOs) require all Medicaid-enrolled providers to submit claims electronically.

How do I verify my Medicaid provider in Iowa?

Call our toll-free Provider Services number at 833-404-1061 from any touch-tone phone and follow the appropriate menu options to docHub our automated member eligibility-verification system 24 hours a day. The automated system will prompt you to enter the member Medicaid ID and the month of service to check eligibility. Eligibility Verification | Medicaid Provider Resources Iowa Total Care providers eligibility-v Iowa Total Care providers eligibility-v

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What is a medical claim number?

A claim number is a unique identification code assigned to a specific medical claim submitted for processing. This number is generated by the insurance company when a healthcare provider or policyholder files a claim for reimbursement of medical services, treatments, or procedures.

What is the phone number for Iowa Medicaid provider?

Questions in completing this application may be directed to Iowa Medicaid Provider Enrollment Unit at (800) 338-7909 (option 2) or (515) 256-4609 (option 2).

How do you get a Medicaid provider number?

0:20 2:56 Application specific to your provider. Type this application is usually available on the statesMoreApplication specific to your provider. Type this application is usually available on the states Medicaid. Website such as the New York State Department of Health. Website. How Do I Find My Medicaid Provider ID Number? - CountyOffice.org YouTube County Office YouTube County Office