Long-Term Services and Supports (LTSS) and Consumer-Directed Attendant Care (CDAC) Claims
Fill out the LTSS Claim for Targeted Medical Care form (PDF). If you need help with this form, refer to the line-by-line instructions (PDF). Once you complete the LTSS Claim for Targeted Medical Care form (PDF), mail it to:
AmeriHealth Caritas Iowa
Attn: Claims Processing Department
P.O. Box 7113
London, KY 40742
Most claims can be submitted on the CMS-1500 paper claim or UB-04. For LTSS and CDAC claim submissions, AmeriHealth Caritas Iowa will accept the universal CMS-1500 paper claim form or the AmeriHealth Caritas Iowa Claim for Targeted Medical Care form. Claims will not be accepted on the Iowa Department of Human Services form 470-2486. Use the CDAC Daily Service Record (PDF) to keep track of services provided to members.
AmeriHealth Caritas Iowa will accept claims submitted for billable Medicaid services for all long-term care and home- and community-based providers currently enrolled with Medicaid until March 31, 2018. This includes providers who have not contracted with AmeriHealth Caritas Iowa and are considered out of network.