Department of Human Services Forms and Office Locations – Government Agency in Iowa

1 - 20 of 70 forms

Form Title	Topics
340B, Federal Supply Schedule, and Nominal Price Attestation and Election
Application for Certification to become a Qualified Entity (QE)
Application for Health Coverage and Help Paying Costs
Attestation of Compliance with Section 6032 of The Federal Deficit Reduction Act
Authorized Representative for Managed Care Appeals
Case Mix Request Access for Iowa Medicaid Portal Access (IMPA) System
CDAC Adjustment
Certificate of Medical Necessity for Health and Disability Waiver Cap Increase
Children's Mental Health Waiver Level of Care Determination Request for Additional Information
Chronic Condition Health Home Managed Care Organizations (MCOs) Notification
Chronic Condition Health Home Program Patient Tier Assignment Tool (PTAT) Guide
Chronic Health Home Program Patient Tier Assignment Tool (PTAT) Version 3.0
Community-Based Neurobehavioral Rehabilitation Services (CNRS) 2018 Provider Quality Management Self-Assessment
Core Standardized Assessment (CSA) Document Access Request for the Iowa Medicaid Portal Access (IMPA) System
Core Standardized Assessment (CSA) Document Access Request for the Iowa Medicaid Portal Access (IMPA) System
Creating Institutional Claims - Nursing Facility
Creating Institutional Claims - Nursing Facility
Creating Institutional Claims - UB04
Creating Professional Claims - CMS 1500
Creating Professional Claims - Dental

Department of Human Services