Contracting & Credentialing Forms
- Contract Request Form (PDF)
- Delegated Practitioner & Facility Roster Form (Excel)
- Facility/Ancillary Provider Application (PDF)
- Iowa Statewide Universal Practitioner Credentialing Application (PDF)
- HCBS Waiver Provider Application (PDF)
- Non-Delegated Practitioner & Facility Roster Form (Excel)
- Provider Change Form (PDF)
- Practitioner Data Form (PDF)
- Iowa Roster Addendum (PDF)
- W-9 Form (PDF)
Submit these forms to Iowa Total Care via email: networkmanagement@iowatotalcare.com.