Medicaid Provider General Letters
The table below contains the 30 most recent letters transmitting changes to Medicaid provider manuals. The most recent letter is listed first. Click on the letter number to view the letter and the transmitted pages. These changes will be incorporated into the chapter on the effective date stated in the letter.
| LETTER NO. | DATE | SUBJECT |
| MM-CN-8 | September 18, 2009 | MANAGEMENT MANUAL, Table of Contents, page 1, revised. |
| EM-CN-21 | August 21, 2009 | Employees’ Manual, Table of Contents, pages 1 and 6, revised. |
| July 17, 2009 | Employees’ Manual, Table of Contents, pages 2, 6, and 7, revised. | |
| June 26, 2009 | General Letter No. 8-AP-299, ALL PROVIDERS MANUAL, Chapter II, Member Eligibility, Table of Contents (page 1), revised, pages 1, 2, 8 through 16, 19, 28, 29, 31, 32 and 33, revised, and the following forms: 470-2580 Presumptive Medicaid Eligibility Notice of Decision, revised 470-2580(S) Presumptive Medicaid Eligibility Notice of Decision (Spanish), new 470-2927 Health Services Application, revised 470-2927(S) Health Services Application (Spanish), revised 470-4299(S) Verification of Emergency Health Care Services (Spanish), new 470-2629 Presumptive Medicaid Income Calculation, revised; Appendix, Table of Contents (page 1), revised, and pages 1 through 17, revised. | |
| EM-CN-19 | May 22, 2009 | Employees’ Manual, Table of Contents, pages 1 through 8 revised. |
| MM-CN-7 | May 22, 2009 | Management Manual, Table of Contents, page 1, revised. |
| All09-1 | May 1, 2009 | General Letter No. 8-AP-298, ALL PROVIDERS MANUAL, Chapter I, General Program Policies, page 40, revised, and form 470-3744, Provider Inquiry, revised; Chapter II, Member Eligibility, page 4, revised, and form 470-2629, Presumptive Medicaid Income Calculation, revised. |
| Inftod09-1 | March 13, 2009 | General Letter No.8-AP-297, Infant and Toddler Program Manual, Table of Contents, page 1, new; Chapter III, Provider-Specific Policies, Table of Contents (pages 1, 2, and 3), revised; pages 1, 2, 3, 12 through 16, and 22 through 52, revised; pages 53 and 54, new; and Remittance Advice, revised. |
| Ledu09-1 | March 13, 2009 | General Letter No. 8-AP-296, LOCAL EDUCATION AGENCY MANUAL, Chapter III, Provider Specific Policies, Contents (pages 2 and 3), revised; pages 1, 9, 18, 24 through 34, 70 through 92, and 95, revised; pages 93, 94, 96, 97, and 98, reissued; and the following forms: |
| MHTH09-1 | January 23, 2009 | General Letter No. 8-AP-295, MATERNAL HEALTH CENTER MANUAL, Table of Contents, page 1, new; Chapter III, Provider Specific Policies, Table of Contents (page 1), revised; pages 1, 2, and 5 through 29, revised; and the Remittance Advice, revised. |
| Sctr09-1 | January 16, 2009 | General Letter No. 294, SCREENING CENTER MANUAL, Table of Contents, new; Chapter III, Provider-Specific Policies, Table of Contents (page 2), revised; pages 3, 4, 13, 14, 15, 23, and 41 through 62, revised; page 63, new; and the following forms: |
| MESD08-1 | December 12, 2008 | General Letter No., 293, MEDICAL EQUIPMENT AND SUPPLY DEALER MANUAL, Title page, revised; Table of Contents, new; Chapter III, Provider-Specific Policies, Title page, new; Table of Contents (pages 1 and 2), new; pages 1 through 61, new; and the following forms: |
| BehavioralHlth08-1 | December 5, 2008 | General Letter No., 292, Behavioral Health Manual, Title Page, new; Table of Contents, new; Chapter I, General Program Policies, Title Page, Table of Contents, pages 1 through 44, and the following forms: 470-4166 Iowa Medicaid Provider Form Request RC-0113 List of Emergency Diagnosis Codes 470-3744 Provider Inquiry 470-0040 Credit/Adjustment Request Chapter II, Member Eligibility, Title Page, Table of Contents (pages and 2), pages 1 through 33, and the following forms: 470-1911 Medical Assistance Eligibility Card 470-2580 Presumptive Medicaid Eligibility Notice of Decision 470-4164 IowaCare Medical Card 470-2927 Health Services Application 470-2927(S) Health Services Application (Spanish) 470-3931 Medically Needy Expense Deletion Request 470-4299 Verification of Emergency Health Care Services 470-2579 Application for Authorization to Make Presumptive Medicaid Eligibility Determinations 470-2582 Memorandum of Understanding Between the Iowa Department of Human Services and the Qualified Provider 470-2629 Presumptive Medicaid Income Calculation 470-3864 Application for Authorization to Make Presumptive Medicaid Eligibility Determinations (BCCT) 470-3865 Memorandum of Understanding With a Qualified Provider for Breast of Cervical Cancer Treatment Chapter III, Provider-Specific Policies, Title Page, new; Table of Contents (pages 1 and 2), new; pages 1 through 17, new; and the following forms: CMS-1500 Health Insurance Claim Form Remittance Advice Appendix, Title Page, Table of Contents, and pages 1 through 18 |
| Drugs08-2 | November 21, 2008 | General Letter No., 291, PRESCRIBED DRUGS, Table of Contents, new; Chapter III, Provider- Specific Policies, Contents (pages 1, 2, and 3), revised; pages 7 through 10, 12 through 32, 32a, 32b, 32c, 38 through 41, 54 through 66, revised; pages 32d and 67 through 79, new; and the following forms: |
| ARNP08-1 | November 21, 2008 | General Letter No., 8-AP-290, ADVANCED REGISTERED NURSE PRACTITIONER MANUAL, Title page, revised; Table of Contents, new; Chapter III, Provider-Specific Policies, Title page, new; Table of Contents (pages 1, 2, and3), new; pages 1 through 92, new; and the following forms: |
| Aea08-1 | August 22, 2008 | General Letter No., 8-AP-289, AREA EDUCATION AGENCY MANUAL, Chapter III, Provider Specific Policies, pages 3, 9, 13, 20, 27, 36, 37, 38, and 43, revised; and form 470-3816, Medicaid Billing Remittance, revised. |
| Remedial08-1 | August 22, 2008 | General Letter No., 8-AP-288, Remedial Services Manual, Contents (page 1), new; Chapter III, Provider-Specific Policies, Contents (pages 1 and 2), revised; pages 1, 2, 3, 15, 17, 18, 19, 28, and 59 through 67, revised; and forms 470-4414, Financial and Statistical Report for Remedial Services, revised; and Remittance Advice, revised. |
| Habilitation08-1 | July 18, 2008 | General Letter No., 8-AP-287, HCBS Habilitation Services Manual, Chapter III, Provider-Specific Policies, Table of Contents (page 1), revised; pages 6, 7, 9, 11 through 15, 22, 23 through 28, 30, 32, 34, 40, 41, 42, 46, 47, 49, and 52 through 58, revised; pages 22a and 22b, new; and the following forms: SES/RA-1 Supported Employment Readiness Analysis, new. 470-4425 Financial and Statistical Report for Habilitation Services, revised |
| RHC08-1 | May 9, 2008 | General Letter No., 8-AP-286, Rural Health Clinic, Title Page, revised; Table of Contents, new; Chapter III, Provider-Specific Policies, Title Page, new; Table of Contents, pages 1 and 2, new; pages 1 through 76, new; and the following forms: |
| Drugs08-1 | May 2, 2008 | General Letter No., 8-AP-285, PRESCRIBED DRUGS, Table of Contents, new; Chapter III, Provider- Specific Policies, Contents (pages 1 and 2), revised; pages 12 through 32, 39, 40, and 41, revised; pages 32a, 32b, and 32c, new; and the following forms: |
| All08-2 | April 4, 2008 | General Letter No., 8-AP-284, ALL PROVIDERS MANUAL, Chapter II, Member Eligibility, form 470-2629, Presumptive Medicaid Income Calculation, revised; Appendix, pages 1 through 11, 13, and 15 through 18, revised. |
| All08-1 | February 22, 2008 | General Letter No., 8-AP-283, ALL PROVIDERS MANUAL, Chapter I, General Program Policies, Contents (page 1), revised; Contents (pages 2 and 3), new; pages 5, 6, and 8 through 44, revised; and the following forms: RC-0113 List of Emergency Diagnosis Codes, new 470-3744 Provider Inquiry, revised 470-0040 Credit/Adjustment Request, revised Chapter II, Member Eligibility, Contents (page 1), revised; pages 1 through 21, revised; and the following forms: 470-1911 Medical Assistance Eligibility Card, revised 470-2580 Presumptive Medicaid Eligibility Notice of Decision, revised 470-4164 IowaCare Medical Card, new 470-2927 Health Services Application, revised 470-2927(S) Health Services Application (Spanish), revised |
| Drug07-3 | December 14, 2007 | General Letter No., 8-AP-282, forms: 470-4116 Request for Prior Authorization: ADD/ADHD/Narcolepsy Agents, revised 470-4095 Request for Prior Authorization: Antihistamines, revised 470-4117 Request for Prior Authorization: Benzodiazepines, revised 470-4104 Request for Prior Authorization: Miscellaneous, revised 470-4105 Request for Prior Authorization: Muscle Relaxants, revised 470-4108 Request for Prior Authorization: Non-Preferred Drug, revised 470-4109 Request for Prior Authorization: Nonsteroidal Anti- Inflammatory Drugs, revised 470-4327 Request for Prior Authorization: Pulmonary Arterial Hypertension Agents, revised 470-4114 Request for Prior Authorization: Tretinoin – Topical, revised 470-4115 Request for Prior Authorization: Vitamins & Minerals, revised |
| AEA07-1 | November 16, 2007 | General Letter No., 8-AP-280, AREA EDUCATION AGENCY MANUAL, Title Page, revised; Table of Contents, new; Chapter III, Provider-Specific Policies, Title Page, new; Table of Contents (pages 1 and 2), new; pages 1 through 43, new; and the following forms: |
| Drugs07-2 | November 2, 2007 | General Letter No., 8-AP-279, Prescribed Drugs, Chapter III, Provider Specific Policies, the following forms: 470-4410 Request for Prior Authorization: Antiemetic-5HT3 Receptor Antagonists/Substance P Neurokinin Product, revised 470-4094 Request for Prior Authorization: Antifungal Drugs, revised 470-4105 Request for Prior Authorization: Muscle Relaxants, revised 470-4112 Request for Prior Authorization: Proton Pump Inhibitors, revised 470-4327 Request for Prior Authorization: Pulmonary Arterial Hypertension Agents, revised 472-4328 Request for Prior Authorization: Sedative/Hypnotics-Non- Benzodiazepine, revised 470-4113 Request for Prior Authorization: Serotonin 5-HT1-Receptor Agonists, revised NCPDP Version 5.1 Payer Sheet, revised |
| MHTH07-1 | October 26, 2007 | General Letter No., 8-AP-278, MATERNAL HEALTH CENTER MANUAL, Title Page, revised; Chapter III, Provider-Specific Policies, Title Page, new; Table of Contents (page 1), new; pages 1 through 30, new; and the following forms: |
| SCTR07-1 | October 26, 2007 | General Letter No., 8-AP-277, SCREENING CENTER MANUAL, Title Page, revised; Chapter III, Provider-Specific Policies, Title Page, new; Table of Contents (pages 1 and 2), new; pages 1 through 62, new; and the following forms: |
| Remedial07-3 | September 14, 2007 | General Letter No., 8-AP-276, Remedial Services Manual, Chapter III, Provider-Specific Policies, pages 11 and 12, revised. |
| Drug07-1 | September 7, 2007 | General Letter No., 8-AP-275, Prescribed Drugs, Chapter III, Provider Specific Policies, Table of Contents (pages 1, 2, and 3), revised; pages 3, 5, 9, 10, and 12 through 61, revised; pages 62 through and 66, new; and the following forms: |
| Rehabcim07-1 | June 29, 2007 | General Letter No., 8-AP-274, Rehabilitation Services for Adults with Chronic Mental Illness Manual, obsolete |
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