provider-survey.css
ia.css
ia.js

News & Announcements

Do more online by registering for Provider Self-Service

Through Provider Self-Service, you can:
  • File and check the status of medical claims
  • Verify eligibility
  • Request precertification
    • Billing at Group level, include Group NPI
    • Billing at Individual Practitioner level, include individual NPI
  • And much more!

To log in, use your Availity ID and password.

If you need an Availity ID, visit www.Availity.com to register today.

Visit Frequently Asked Questions about Availity for more information.

Provider Self-Service

 Provider Resources & Documents

expand Behavioral Health
Mental Health Outpatient Treatment Form-hawk-i
Behavioral Health Discharge Note-IA Health Link
Behavioral Health Initial Review Form-IA Health Link
Psychological Testing Request for Authorization-IA Health Link
Coordination of Care Form-IA Health Link
Neuropsychological Testing Request for Authorization-IA Health Link
BH hawk-i Covered Benefits Grid
Applied Behavior Analysis Authorization Request Form
Behavioral Health - Health and Wellness Covered Benefits
Behavioral Health Psychiatric Medical Institute for Children Initial/Concurrent Review Form-IA Health Link
Behavioral Health Psychiatric Medical Institute for Children Initial
Concurrent Review Form-IA Health Link
expand Claims Submission and Reimbursement Policy
UB-04 Claim Form
CMS 1500 Claim Form
expand Clinical Practice Guidelines
Clinical Practice Guidelines Matrix
expand Critical Incident Form
Critical Incident Form
expand Disease Management Centralized Care Unit
About DMCCU
Provider Rights and Responsibilities
expand EPSDT
EPSDT Reminder Program
expand Find Your Provider Representative
For Hospital Questions: Hospital Consultant Map
For Practice Consultant Questions: Quality Management Consultant Map
For General Medical Questions: General Medical Consultant Map
expand Forms
Medical Injectable Prior Authorization Form-IA Health Link
Recoupment Notification Form-IA Health Link
Overpayment Refund Notification Form-IA Health Link
Medical Injectable Prior Authorization Form-hawk-i
Primary Care Provider Change Request Form-hawk-i
Universal Precertification Request Form
expand Health Home
Health Homes Brochure
Health Home Extra Benefit Request Form
expand Health Home Notification Form
Health Home Notification Form
expand ICD-10
expand Long Term Services and Supports (LTSS)
Claim for Targeted Medical Care Instructions
Claim for Targeted Medical Care Form
expand Manuals & Referral Directories
Quick Reference Card
expand Maternal Child Program
Maternity Notification Form
Taking Care of Baby and Me Flier
Prenatal ultrasound coverage and coding
Healthy Rewards Program
expand Medical Management Model
Care Management
Medical Management Model
expand Newsletters - Archived
Provider News Issue 1 2016
Provider News Issue 3 2016
2017 Quarter 1 Provider Newsletter
expand Newsletters - Current
2017 Quarter 3 Provider Newsletter
February 2018 Provider Newsletter
expand Pharmacy
Preferred Drug List
Pharmacy Tools
Dual Eligible LINET Quick Reference Guide
Synagis Prior Authorization Process Overview
American Academy of Pediatrics ADHD Clinical Practice Guideline
expand Quality Management
Healthy Rewards Flier
2017 HEDIS Overview for Providers
expand Quick Tools
Precertification Lookup Tool
Reimbursement Policies
Experimental and Investigational Procedure Codes
expand Screenings
PHQ-9 Depression Screening
Michigan Alcohol Screening Test (MAST)
CAGE-AID SUD Screening
Assist SUD Screening
Audit Alcohol Use Questionnaire
expand State Communications
340B Drug Pricing Program
Informational Letters
expand Training Programs
Interpreter Services Desktop Reference Card
IA Nursing Facility Orientation
IA Consumer Directed Attendant Care (CDAC) Orientation
Electronic Filing Options
Cultural Competency Toolkit
Individual CDAC Provider Training
My Diverse Patient Training: Reducing Health Care Stereotype Threat
Peer Support Services Flier
expand Tutorials
Provider Website Guide
Claims Appeal Tutorial
Remittance Viewer Process Guide
expand Vendor/Partner Links & Information
Express Scripts Provider Portal
Express Scripts Pharmacy Locator Tool
Iowa