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

41 - 60 of 70 forms

Form Title	Topics
Iowa Medicaid Health Home Provider Agreement
Iowa Medicaid Health Home Provider Application
Iowa Medicaid Integrated Health Home Provider Agreement General Terms
Iowa Medicaid Managed Care Wraparound Payment Request Form
Iowa Medicaid Meals and Lodging Claim
Iowa Medicaid Mileage Reimbursement Trip Log and Claim Form
Iowa Medicaid Notice of Decision - Access2Care
Iowa Medicaid Point of Sale Agreement
Iowa Medicaid Provider Address Change Request Form
Iowa Medicaid Qualified Medicare Beneficiaries (QMB) or Health Insurance Premium Payment (HIPP) Program Provider Enrollment Application
Iowa Medicaid Universal HCBS Waiver Provider Application
Iowa Wellness Plan ACO Readiness Application
Level of Care Certification for Swing Bed Facility
Managed Care Organization Enrollment
Medicaid/Hawki Review
Medicaid Member Documentation Upload Cover Sheet through the Iowa Medicaid Portal Access (IMPA) System
Medicaid/State Supplementary Assistance Review
Medicaid Supplemental Information Prior Authorization
Medically Exempt Attestation and Referral Form
Medically Exempt Member Survey

Department of Human Services