Thanks for your interest!

If you have an Iowa Medicaid number and are enrolled in Council for Affordable Quality Healthcare (CAQH), please complete the online application request, the Iowa Disclosure of Ownership form and a current W-9, and fax to 1-855-832-7289 or email.

If you have not enrolled in CAQH, please complete the online application request, complete all of the documents below and fax to 1-855-832-7289 or email to email.

We cannot initiate credentialing unless all information is current. Your application for credentialing does not guarantee network participation. You cannot begin seeing Amerigroup Iowa, Inc. members until you receive notification of your effective date for participation with Amerigroup, indicated by an executed contract and completed credentialing. After submission of all documents, Provider Relations will contact you within three business days with further instructions.

• Physician/Practitioner Application checklist
• Practitioner application
• Provider Entity Disclosure form
• W-9 form

If you are new to the Amerigroup Iowa, Inc. network, you will be required to submit both credentialing application and a signed contract. Please complete all of the documents below and fax to 1-855-832-7289 or email.

We cannot initiate credentialing unless all information is current. Your application for credentialing does not guarantee network participation. You cannot begin seeing Amerigroup members until you receive notification of your effective date for participation with Amerigroup, indicated by an executed contract and completed credentialing. After submission of all documents, Provider Relations will contact you within three business days with further instructions.

• Provider/Facility and Long-Term Services and Supports Provider application
• Ancillary/Facility/Long-Term Care Provider Application checklist
• Provider Entity Disclosure form
• W-9 form

For questions, please contact Amerigroup Iowa Provider Relations at 1-855-789-7989 or via email