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Iowa Care for Yourself Program
June 2013 Health Care Provider Guide
Health Care Provider Guide
Iowa Department of Public Health Chronic Disease Prevention & Management
Lucas State Office Building 321 E. 12th Street
Des Moines, IA 50319-0075 (515) 281-5616
www.idph.state.ia.us/CFY
• Provide an electronic interface for Department staff to document dates of each approved service provider’s enrollment in the direct service programs; and
• Retain staff: o Who will appropriately process all claims with a 2-3 week timeframe following
receipt of the claim; o With excellent verbal and writing skills; o With excellent computer skills; o With successful experience in database creation and maintenance, and report
generation; o Who are able to analyze health claims; and o Who are able to effectively communicate with health care provider billing staff
about denial of claims, when applicable.
Work and services specific to the Chronic Disease Service Programs Billing and Claims Processing: • Provide technical assistance to the DEPARTMENT and its contracted Chronic Disease
Service Programs providers; • Provide guidance regarding approved changes in the billing process; • Review and provide assistance with revising the billing procedure sections of the provider
guidelines; • Conduct billing procedure training as needed at Department-initiated meetings for local
program coordinators; • Respond to billing questions and concerns from approved service providers, Department
staff and local contractors within 1 week of receipt of question or concern; • Provide electronic copies of billing data to state and local Department staff upon request; • Revise billing and claim payment software as needed; and • Inform Department of annual changes in covered the direct service programs codes and
Medicare Part B Participating Provider and Medicaid payment rates to facilitate accurate and timely payment of claims.
• Reimburse approved service providers located in and outside Iowa for covered services; • Reimburse claims for the Cervical Cancer Project according to the Medicaid rate schedule;
and • Reimburse claims for the WISEWOMAN, Care for Yourself and Iowa Get Screened
Programs at the approved Medicare Part B Participating Provider Rates for Iowa, or at a rate as designated by the DEPARTMENT Program Consultant or Bureau Chief;
Article VII – Performance Measure is amended to add language (in bold) as follows:
2) Contract outputs related to Contract Purpose - as measured by processing and reimbursement of claims.
a) CRITERIA: Payment of the final five (5) percent of the Chronic Disease Service Program claim processing amount shall be withheld pending timely processing and reimbursement, and submission of the final claim vouchers and expenditure reports for that program.
b) MEASURE: Timely processing and reimbursement is defined as all claims received by Contractor for services on or before June 29, 2015 are processed,
Local Site Limited (BCC) Comprehensive (WW) Total Komen Screens Total BCCEDPAppanoose 140 95 0 235Black Hawk 305 95 100 400Boone 16 5 16Butler 119 15 119Calhoun 100 20 100Carroll 70 15 70Cass 150 150 64 300Cerro Gordo 125 42 125Clarke 75 10 75Clinton 150 80 20 230Dallas 60 5 60Dubuque 105 110 50 215Hancock 45 5 45Hardin 86 10 86Henry 65 15 65Kossuth 80 20 80Linn 210 14 210Lucas 15 0 15Marion 88 12 88Palo Alto 35 70 30 105Polk 706 260 100 966Scott 291 0 291Taylor 202 66 202Washington 208 55 208Winnebago 19 0 19Woodbury 281 140 0 421Worth 20 7 20Total 3766 1000 680 4766
*this is part of the BCC and WW
updated 6.20.14
FY15 (June 30, 2014 - June 29, 2015)
Iowa Care for Yourself Program
June 2013 Page 5 Health Care Provider Guide
INTRODUCTION
Thank you for being part of the Iowa Care for Yourself (IA CFY) Program. The Health Care Provider
Guide is to help participating health care professionals understand program requirements and provide
screening services to program-eligible women.
PROGRAM STRUCTURE
The IA CFY Program has 27 local programs that provide navigation and supervision of service delivery
for participants in all counties of Iowa. Local Boards of Health identify a lead agency to manage their
area’s IA CFY Program.
IA CFY Program services emphasize:
Breast and cervical cancer screening for the target population
Reaching women never or rarely screened for cervical cancer
Reducing over-screening for cervical cancer
Case management for participants requiring diagnostic services, breast or cervical cancer
treatment, and
Rescreening services to women on an annual basis, if eligible.
ELIGIBILITY
The Iowa Care for Yourself Program provides services for women:
Age 40 and over
Under age 40 with breast cancer symptoms
Household income at or less than 250% of the poverty level for household size set by the federal
government. Check the Care for Yourself Program website for current Income Guidelines
No health insurance, insurance that does not cover the services provided by the program, or
unable to pay insurance deductibles or co-payments.
Insurance coverage does not exclude an eligible woman. Insurance plans can include a
deductible, co-pay or waiver stating that treatment for breast or cervical cancer will not be paid.
If a woman does have insurance coverage for any or all services and meets age and income
guidelines she may be eligible. Claims for services are to be submitted to the participant’s
insurance company for payment before submission to IA CFY Program.
The Care for Yourself Program does not provide services for:
Men
Women with Medicare Part B
Women age 39 and younger unless they have symptoms of breast cancer
Iowa Care for Yourself Program
June 2013 Page 12 Health Care Provider Guide
4 Appanoose
Jackie Kelly
One St. Joseph’s Dr.
Centerville, IA 52544
641.437.4420
14 Carroll/Sac
Lisa Stoelk
318 S. Maple, Ste. #3
Carroll, IA 51401
712.794.5279
31 Dubuque
Cathy Tieskoetter
P.O. Box 359
Dubuque, IA 52004
563.556.6200
57 Linn
Cindy Fiester
501 13th Street NW
Cedar Rapids, IA 52405
319.892.6081
87 Taylor
Karen Norton
405 Jefferson St. #7
Bedford, IA 50833
712.523.2158
7 Black Hawk
Gabbi DeWitt
1407 Independence Ave.
Waterloo, IA 50703
319.292.2225
15 Cass
Karla Akers
1501 E. 10th St
Atlantic, IA 50022
712.243.7443
41 Hancock
Jami Hagen
532 1st Street NW
Britt, IA 50423
641.843.5194
59 Lucas
Mary Grismore
123 S. Grand, PO Box 852
Chariton, IA 50049
641.774.4312
92 Washington
Lisa Heisdorffer
311 N. 4th Ave
Washington, IA 52353
319.653.4850
8 Boone
Katie Hagan
105 S. Marshall
Boone, IA 50036
515.433.8325
17 Cerro Gordo
Teresa Symens
22 N. Georgia St S
Ste 300
Mason City, IA 50401
641.421.9315
42 Hardin
Kim Miles
2411 Edington Ave
Eldora, IA 50627
641.939.8444
63 Marion
Carla Boat
2003 N Lincoln
PO Box 152
Knoxville, IA 50138
641.828.2238
95 Winnebago
Karen Kester
216 S. 4th St
Forest City, IA 50436
641.585.4763
12 Butler
Becky Newton
Courthouse, PO Box 325
Allison, IA 50602
319.267.2934
20 Clarke
Kelly Bailey
134 W. Jefferson St
Osceola, IA 50213
641.342.3724
44 Henry
Cindy Litchfield
407 S. White St
Mt. Pleasant, IA
52641
319.385.6568
74 Palo Alto
Candace Bisenius
3201 W. 1st Stt
Emmetsburg, IA 50536
712.852.5419
97 Woodbury
Lori Jackson
1014 Nebraska St
Sioux City, IA 51105
712.279.6119
13 Calhoun
Tami Mohr
501 Court St
Rockwell City, IA 50579
712.297.8323
23 Clinton
Dona Bark
611 N. 2nd Street
Clinton, IA 52732
563.244.4925
55 Kossuth
Mary Hilbert
1515 S. Phillips St
Algona, IA 50511
515.295.2451
77 Polk
Louanne Williams
1907 Carpenter Ave.
Des Moines, IA 50314
515.286.2095
98 Worth
Diane Myli
95 9th Street N.
Northwood, IA 50459
641.324.1741
25 Dallas
Jennifer Kirstein
2423 Willis Ave
Perry, IA 50220
515.993.1753
82 Scott
Stefanie Dreher
1228 E. Rusholme, Ste. #210
Davenport, IA 52803
563.421.7620
Revised 7.1.13
Enrollment Sites
CASE MANAGEMENT SERVICES Each participant who requires follow-up, diagnostic services or treatment will receive case management
services from local IA CFY Program staff to help assure appropriate and timely follow-up care. The
local IA CFY Program coordinator and participant will develop a needs assessment and plan of action (if
applicable). Please contact local CFY Program staff to help facilitate a participant’s services.
Iowa Care for Yourself Service Area Map
June 29, 2013 - June 30, 2014
Iowa Care for Yourself Program
June 2013 Page 2 Health Care Provider Guide
CFY Program Services for Eligible Women
Services Included:
An office visit that includes appropriate/recommended breast and cervical cancer
screening:
Two blood pressure measurements
Height, Weight, Body Mass Index (BMI)
Clinical breast exam
Pelvic exam
Pap test as eligible and recommended by provider
Mammography as recommended by provider
Breast and/or cervical diagnostic services as recommended by provider
Tobacco cessation referral
Referral for precancer and cancer treatment as recommended by provider
Iowa Department of Public Health Chronic Disease Prevention & Management
Lucas State Office Building 321 E. 12th Street
Des Moines, IA 50319-0075 (515) 281-5616
www.idph.state.ia.us/CFY
Iowa Care for Yourself Program
June 2013 Page 13 Health Care Provider Guide
REIMBURSEMENT SERVICES The IA CFY Program contracts with Provider Claim Systems (PCS), a division of North Iowa
Community Action Organization, to process claims and reimburse health care providers for covered
services.
Reimbursable Services
Refer to the provider section on the CFY website regarding reimbursement services and payment
schedule. Federal law requires that reimbursement with federal funds may not exceed Iowa Medicare
Part B rates. Medicare and IA CFY Program reimbursement rates are updated annually. Updated
information is available to IA CFY Program participating health care providers and their billing agencies
on the Care for Yourself website found at http://www.idph.state.ia.us/CFY.
A woman enrolled in the IA CFY Program should not be billed for:
o Any IA CFY Program covered service, and
o Collection and transportation of specimens. These costs are to be included in the office visit
reimbursement. They should not be billed separately.
CLAIM FORMS
Originals of the HCFA 1500 and the UB 04 are the only accepted forms to submit claims for
payment. The following information must be included for a claim to be processed:
Participant name and address
Participant ID number
Participant Birth date
Date of service
CPT code for each approved service(s) provided
Charge for service
Facility name, address, Tax ID number and NPI number
Billing name, address and NPI number
If insurance is involved, complete the following:
For the HCFA 1500, Boxes 28 (Total Charge), 29 (Amount Paid), & 30 (Balance Due)
For the UB 04, Boxes 54 (Prior Payments) and 55 (Est. Amount Due)
Submit the Explanation of Benefits (EOB) from an insurance company
Claims Reimbursement Report
Iowa Care for Yourself Program is the payer of last resort. An Explanation of Benefits (EOB) must be
obtained from an insurance company when appropriate. Submit the EOB to Provider Claim Systems. PCS will
reimburse for co-pay and deductibles up to the amount indicated on the Iowa Care for Yourself Reimbursement
Schedule.
When claims payment is made, PCS will enclose a list of participating patient/clients with the payment. The list
will include the woman’s name, date of birth, date of service, the CPT code, and amount paid. A woman may not
be billed for Care for Yourself Program-covered services. An IA CFY Program participant may be billed
for services not covered by the program.
stomach
small
intestine
colon (large intestine)
rectum
anus
If you do have symptoms, they may
include:
Blood in your stool
Belly pain for no clear reason
Losing weight for no clear reason
REMEMBER:
Most people have no symptoms at
all!
Do you have close family members who have had colorectal cancer?
If so, you may be at a higher risk of
Colorectal Cancer
Cancer that starts as a polyp or growth in the colon (large intestine) or rectum.
Screening detects these polyps and allows them to be removed before turning into cancer. Colorectal cancer is one of the only cancers that can be prevented through screening.
If everyone age 50 and older had regular colorectal cancer screenings, as many as 80% of deaths from colorectal cancer could be prevented.
A tiny growth or “polyp” in the wall of the colon or rectum
Program Eligibility
The Iowa Get Screened program provides screening services to people who meet the following eligibility criteria:
Iowa resident
Age 50 – 64
Uninsured or underinsured
250% of Federal Poverty Level or
below
At an average or increased risk for
colorectal cancer
Not experiencing:
Ongoing rectal bleeding
Prolonged changes in bowel
habits
Persistent abdominal pain
Recurring symptoms of
bowel obstruction or
significant unintentional
weight loss
Have not been diagnosed with:
Crohn’s disease
Ulcerative colitis
Inflammatory bowel
disease
Preventable Treatable Beatable
Get Screened
Everyone age 50 and older should be screened for colorectal cancer. If you have a personal or family history of colorectal cancer or polyps, talk to your doctor about getting screened before the age of 50.
There are screening options - talk to your doctor about the one that’s right for you.
Signs & Symptoms
7 out of 10 people with colon
cancer have no symptoms!
Call your doctor if you experience any
of the symptoms below:
Blood in your stool
Persistent abdominal pain or cramps
Change in bowel habits
Weight loss for unknown reasons
Diarrhea/constipation
Constant tiredness
Nausea or vomiting
Stomach
Anus
Small
Intestine
Colon (large
intestine)
Rectum
IGS Screening Numbers FY 2015 • Black Hawk County Public Health-115 • Carroll/Sac –15 • Polk County Public Health-60 • Linn County Public Health-60 • Cerro Gordo Public Health-5 • Clarke County Public Health-5 • Proteus-20 • Promise Community Health Center-30 • His Hands Ministry Free Clinic-10 • St. Luke’s Hospital --60 • Genesis Hospital-5
The Iowa Department of Public Health is pleased to announce the availability of funds for children in need of hearing aids and/or audiological services. Funding was made possible through an appropriation by the Legislature during the last legislative session (14). Funds are limited, therefore claims will be processed on a first come, first serve basis and considered as payor of last resort. Claims will be accepted for services July 1, 2014 through June 1, 2015 or until the funds run out. If you know of a child in need of hearing aids or audiological services,
please have the family contact Provider Claim Systems at (800) 547-6789 for an application or click on the link under Funding Announcement entitled Application. Completed applications can be faxed or mailed to Provider Claim Systems as follows: Provider Claim Systems P.O. Box 1608 Mason City, IA 50402-1608 Phone: (800) 547-6789 – toll free Fax: (641) 422-2713 Claims will be reimbursed based on Medicaid rates. If you have further questions, please contact Provider Claim Systems at the number listed above.
Iowa’s Early Hearing
Detection and Intervention
Program
Funding Announcement – Hearing Aids and Audiological Services
