Medicaid Provider Enrollment

Overview
Enrollment
FAQ


OVERVIEW
On February 20, 2020, Iowa Department of Human Services (DHS) released
 Informational Letter No. 2105-MC-FFS (replacing Informational Letter No. 2048 dated November 18, 2019) detailing the process for pharmacists to enroll as providers into provide services under the Board of Pharmacy-approved statewide protocols. DHS stated that Iowa Medicaid has added a new provider type for pharmacists, allowing pharmacists to enroll as a Medicaid provider immediately. As stated in the letter, enrollment will permit a pharmacist, pursuant to statewide protocols, to order and dispense naloxone and nicotine replacement therapy products, as well as to order and administer vaccines to Medicaid members.  

Click here to access an Iowa Medicaid Provider Enrollment resource created by IPA. 
 

ENROLLMENT
Enrollment is through a paper application only. There is no fee to enroll as a Medicaid provider with the IME.  

To enroll under this new provider type, a pharmacist must:
1. Complete the 
Iowa Medicaid Universal Provider Enrollment Application Form 470-0254 (Section B)
     a. In box 16, enter type code 82.
     b. In boxes 31 a-c, enter the pharmacy NPI, Taxonomy Code, and Location Zip Code. If employed at more than one location (pharmacy), you will have to submit a completed application for each location. 

  • Include a copy of your Iowa Board of Pharmacy Pharmacist License. Obtain through the Board of Pharmacy’s new online portal. 
  • Include a copy of the certificate from a college of pharmacy or an ACPE-accredited CE program on vaccine administration (if applicable). 
  • Include a copy of current basic cardiac life support or CPR training certificate.
  • Include a copy of all applicable ACPE-approved CE certificates relative to vaccines, naloxone, and nicotine replacement therapy.  
2. To be recognized by AmeriGroup, complete Iowa Medicaid Universal Provider Enrollment Application Form 470-0254 (Section C). In lieu of completing Section C, you can complete the credentialing process with the Council for Affordable Quality Healthcare (CAQH), a nationally recognized online credentialing service.
     a. Please note that Iowa Total Care does not require you to complete Section C or use CAQH.



FAQ
Pharmacist Affiliation 
Can a pharmacist enroll if not affiliated with a pharmacy? 

Yes. If a pharmacist enrolls under their individual Social Security Number, they will be required to submit additional enrollment forms including: 

  • 470-0254Section A, 
  • Provider Agreement Form 470-2965,
  • Electronic Funds form 470-4202, IRS form W-9. 
How does a pharmacist affiliated with a medical office enroll? The pharmacist would enroll and link themselves to the physician group. 
Managed Care 
Will the MCOs have an additional provider enrollment process? 

Only AmeriGroup has an additional enrollment/credentialing process. This can be completed by completing Section C of the application or complete the credentialing process with the Council for Affordable Quality Healthcare (CAQH), a nationally-recognized online credentialing service. 

Additional questions related to MCO enrollment should be directed to the appropriate MCO.

Does the IME provide guidance to the MCOs on their enrollment process?  No. Each MCO has their own credentialing requirements.
Continuing Education (CE) 
Will pharmacists need to submit new education verification with each renewal period?  Yes.
How far back do you need CE? 

Provide the CE indicated in 29 a-c. 

  • For a. that means the initial qualification (course) as noted under “i”. Then current certificates under “ii-iii” as required under the Board of Pharmacy’s rules within the license renewal period.
  • For b. and c. that means the certificate for the CE in each area obtained during the current or past licensing period as required under the Board of Pharmacy’s rules. 
General
Does the IME work with credential verification services for providers?  No.
Is there an online application? No, there is not an online application. Enrollment is through a paper application only. 
Is there a fee to enroll as a Medicaid provider?  No.
Is it possible for an employer (e.g., office manager) to submit on behalf of employee pharmacists (e.g., clinics, hospitals, chains)? If so, what will the process be for this?  Yes. The process is the same.