State Provider Enrollment - Frequently Asked Questions

Who needs to enroll in Iowa Medicaid?

Any provider who would like to receive Medicaid reimbursement for services rendered to Iowa Total Care Medicaid recipients. This includes rendering and billing providers, groups and facilities.

How do I enroll?

To enroll with Iowa Medicaid, providers must complete the Iowa Medicaid Provider Enrollment Application and submit it to the Iowa Medicaid Enterprise (IME) Provider Enrollment Unit. The enrollment application is used to screen and verify that the provider has met federal regulations and state requirements prior to enrollment.

What information do I need?

New enrollees and those with a new tax identification number (id):

If you are enrolling in the Iowa Medicaid program for the first time or are already enrolled, but have a new Tax ID, the following forms are required:

• Form 470-0254, Iowa Medicaid Universal Provider Enrollment Application
• Form 470-2965, Iowa Medicaid Provider Agreement General Terms
• Form 470-4202, Electronic Fund Transfer (EFT) Authorization
• IRS Form W-9
• Form 470-5112, Designated Contact Person

Adding an individual or sub-part to your organization:

• Form 470-0254, Iowa Medicaid Universal Provider Enrollment Application (Section B)

Submit the completed enrollment forms and all supporting documentation to:

Iowa Medicaid Enterprise
Provider Enrollment Unit
PO Box 36450
Des Moines, Iowa 50315

OR email: imeproviderenrollment@dhs.state.ia.us

Who should I contact with further questions?

If you have any questions regarding the provider enrollment process, please contact the IME Provider Enrollment Unit at 1-800-338-7909 or by email at: imeproviderenrollment@dhs.state.ia.us
For questions concerning why Envolve has requested you take action, please contact Customer Service at 1-833-564-1205.