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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.

You can use the Claim for Targeted Medical Care form (PDF) along with line-by-line instructions (PDF). Or call Provider Services at 1-844-411-0579, and a supply will be sent to you.

Get answers to frequently asked questions from CDAC providers (PDF).