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On Feb. 21, 2024, Change Healthcare experienced a cybersecurity incident. Any individuals impacted by this incident will receive a letter in the mail. Learn more about this from Change Healthcare’s website or reach out to their contact center: 1-866-262-5342.

Manuals, Forms and Resources

Manuals 

  • Provider Manual (PDF) - Includes information on, but not limited to, program benefits and limitations, prior authorizations, urgent and emergency care, member rights, provider rights for advocating on behalf of members, cultural competence, grievances and appeals, key contacts, Iowa Total Care’s billing guidelines, cost sharing requirements, and policies and procedures for third party liability and other collections. (For information on routine vision services, see the Envolve Vision Office Manual link below.)
  • Consumer-Directed Attendant Care (CDAC) User Guide (PDF) - Includes information on CDAC services covered by Iowa Total Care. 
  • Envolve Vision Office Manual – Includes information on routine vision services. After creating an account, use the Eye Health Manager provider portal to view the office manual, plan specifications, policies and procedures, verify member eligibility, manage claims, check the status of a claim, review past claim submissions, and reprint EOPs.

Forms

*Before filling out the forms below, right-click on the link and choose “Save Link As” to save it to your desktop. This will make sure the file shows the information correctly.

Visit the Iowa HHS Prior Authorization webpage for the uniform prior authorization forms/guides listed below:

  • Outpatient Medicaid Prior Authorization Form, 470-5595 | 470-5595 Resource Guide (Comm. 039)
  • Inpatient Medicaid Prior Authorization Form, 470-5594 | 470-5594 Resource Guide (Comm. 038)
  • Supplemental Form (470-5619)

Provider Contracting & Credentialing Forms have been moved to the Contracting & Credentialing Forms page.

Provider Resources