Iowa Admin. Code r. 441-74.13 - Claims and reimbursement methodologies

Current through Register Vol. 44, No. 12, December 15, 2021

(1) Claims for services not provided by a qualified health plan. Claims for services provided under the Iowa wellness plan or for covered marketplace choice services not provided by the member's qualified health plan shall be submitted to the Iowa Medicaid enterprise as required by 441-Chapter 80 or to the member's Medicaid managed care organization.
(2) Payment for services not provided by a qualified health plan. Payment for services provided under the Iowa wellness plan or for covered marketplace choice services not provided by the member's qualified health plan shall be provided in accordance with 441-Chapter 79 or as provided in a contract between the department or the member's Medicaid managed care organization and the provider.
(3) Payment for services provided by the marketplace choice plan. Payment for services provided under the marketplace choice plan shall be made in accordance with the rates filed with the Iowa insurance division.

Notes

Iowa Admin. Code r. 441-74.13
ARC 1135C, IAB 10/30/2013, effective 10/2/2013 Amended by IAB January 6, 2016/Volume XXXVIII, Number 14, effective 1/1/2016

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