Department of Human Services

State of Iowa

Official Website: https://dhs.iowa.gov/

Forms & Documents

Browse all Department of Human Services government forms

21 - 40 of 70 forms

Form Title Topics
Creating Professional Claims - Waiver/Targeted Case Mgmt.
Dental Wellness Plan Wraparound Payment Request
Designated Contact Person
Early Periodic Screening Diagnosis and Treatment (EPSDT) Functional Needs Acuity Scoring Tool (FNAST)
Early Periodic Screening Diagnosis and Treatment (EPSDT) Medical Needs Acuity Scoring Tool (MNAST)
Early Periodic Screening Diagnosis and Treatment (EPSDT) Social Needs Acuity Scoring Tool (SNAST)
Family Planning Program Provider Attestation
Health Insurance Premium Payment (HIPP) Provider Invoice
Home- and Community-Based Services (HCBS) Brain Injury Waiver Emergency Need Assessment
Home- and Community-Based Services (HCBS) Intellectual Disability Waiver Priority Need Assessment – Statewide Waiting List
Home- and Community-Based Services (HCBS) Nonresidential Setting Assessment
Home- and Community-Based Services (HCBS) Residential Setting Member Assessment
Inpatient Medicaid Prior Authorization
Insurance Update Fee-for-Service (FFS) Members
Integrated Health Homes (IHH) Managed Care Organizations (MCOs) Notification
Intermediate Care Facilities for Individuals with an Intellectual Disability Calculation Worksheet
Iowa Medicaid Accountable Care Organization (ACO) Agreement
Iowa Medicaid Addendum to Dental Provider Agreement for Orthodontia
Iowa Medicaid Enterprise (IME) Inpatient Psychiatric Prior Authorization
Iowa Medicaid Enterprise (IME) Provider Enrollment Application Fee Hardship Exemption Request

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