The Managed Care Ombudsman Program partners with providers who serve and support Medicaid managed care members. The Managed Care Ombudsman Program:
- Acts as an advocate for Medicaid managed care members who live or receive care in a health care facility, such as a nursing facility or Intermediate Care Facility for individuals with Intellectual Disabilities (ICF/ID), assisted living program or elder group home;
- Acts as an advocate for Medicaid managed care members enrolled in one of the seven home and community-based services (HCBS) waiver programs;
- Investigates complaints made by, or on behalf of, members;
- Serves as a resource for answers regarding managed care rules and members’ rights;
- Provides information, education, awareness and training about managed care options and members’ rights;
- Promotes policy changes to improve the quality of life and care for Medicaid managed care members; and
- Partners with providers to assist with member issues and concerns.
Providers who serve and support Medicaid managed care members are encouraged to:
- Assist Medicaid managed care members in understanding their rights and responsibilities;
- Collaborate with members in designing a person-centered care plan;
- Notify a community-based case manager of any significant changes in a member’s condition or care, including hospitalizations or recommendations for additional services;
- Advise or advocate on behalf of a member with the member’s consent; and
- Assist Medicaid managed care members in filing a grievance or appeal when they need assistance.
Contact information for each of Iowa's MCOs is listed below:
Amerigroup Iowa, Inc.
Provider Services: 800-454-3730 (7:30 a.m. – 6 p.m., Monday through Friday)
Amerigroup On-Call Hours: 866-864-2544 or Spanish 866-864-2545 (available 24/7)
Iowa Total Care
You can attend MCO stakeholder's meetings to communicate issues or concerns.
Each MCO hosts stakeholder's meetings for members and providers to attend to discuss issues and concerns. Call the MCO to find out when and where the next meeting will be held.
Prior authorizations for members to receive a service or benefit are requested by the provider or pharmacy, not the member.
If a member needs a specific service or benefit and it requires a prior authorization, providers are expected to submit the prior authorization on behalf of the member.
Each MCO has tools and resources specifically designed for providers.
Providers should stay up-to-date on policies and procedures to ensure the highest quality of care for members. Follow the provider-specific links below to find newsletters, training documents, resources and updates from each MCO:
Each MCO provides support to providers through a provider escalation email address, provider relations service or provider relations advocate.
Each MCO has specific contacts and supports for providers. Your provider manual should describe those resources available to you. The link to each MCO provider manual is provided above.