Providers and Partners

Iowa Health Advantage firmly believes that our success as a health plan hinges on our participating Providers. And we are committed to simplifying the administration of health insurance so our Providers can devote their attention to providing high-quality health care. We are always available if questions arise, and we collaborate with our Providers to help facilitate the efficient delivery of quality care to our Members.

Iowa Health Advantage provides Medicare Part D prescription drug coverage through our partner Elixir Solutions. Elixir Solutions is a full-service pharmacy benefit management company committed to lowering drug costs, improving health, and providing superior customer service in a manner that instills trust and confidence.

Part B Drugs, drugs that are not usually self-administered and are administered as part of a physician or outpatient service, click here.

Medicare Part B covers drugs, such as the following:

• • Drugs requiring an infusion pump;
  • Immunosuppressive drugs for people who had a Medicare covered transplant;
  • Hemophilia clotting factors;
  • Antigens;
  • Intravenous immune globulin provided in the home;
  • Erythropoietin for people with end stage renal disease (ESRD);
  • Parenteral nutrition for people with a permanent dysfunction of their digestive tract.
  • Regional differences in Part B drug coverage policies can occur in the absence of a national coverage decision.

Part D Drugs, Drugs available only by prescription, approved by the FDA, and used for a medically accepted indication which are not covered under Part B (or Part A), see below:

For Prescribers:

• • Access Formulary and Prior Authorization Forms at https://elixirsolutions.promptpa.com
    • Select “Prescribers” and click on “Prior Authorization”
    • Enter your NPI number and State to access the prescriber portal
  • Elixir Pharmacy Helpdesk
    • Phone number: 1-855-476-7801
    • TTY phone number: 711
  • Refer to the Prescription Drug Benefit page for formulary, prior authorization criteria, and step therapy criteria

For Pharmacies:

• • Access payer sheets and other information at https://elixirsolutions.promptpa.com
    • Select “Pharmacies” and click “Pharmacies Login”
    • Enter your NPI number and NCPDP number to access the pharmacy portal
  • Elixir Pharmacy Helpdesk
    • Phone number: 1-855-476-7801
    • TTY phone number: 711
  • Refer to the Prescription Drug Benefit page for formulary, prior authorization criteria, and step therapy criteria

At Iowa Health Advantage, we specialize in improving health care and advancing a truly unique philosophy of care to meet the complex needs of the institutional Medicare beneficiary population, while simultaneously streamlining administrative functions for our Providers. The Iowa Health Advantage Model of Care focuses on providing a unique level of customized clinical care and services for residents in nursing facilities or individuals living in the community or a contracted assisted living facility (ALF) but require an institutional level of care (LOC) As we help extend your care, our care model concentrates on addressing each Member’s full range of medical, functional, and behavioral health care needs in a coordinated and Member-centric manner. This means putting the Member’s preferences at the center of the care planning process and leveraging Provider resources to ensure every Member receives the services necessary to achieve their short-term and long-term care goals. Our model organizes best practices and industry innovations including:

• • The Advanced Nurse Practitioner (ANP) and primary care physician (PCP)/NFist (a PCP specializing in the care of nursing home patients) care team providing onsite, facility-based PCP support;
  • A risk-assessment tool designed for a senior, nursing facility patient population;
  • A comprehensive history and physical assessment that generates an Individualized Care Plan (ICP);
  • A care management platform that helps identify needed preventive health/HEDIS services, ensures the use of evidence-based clinical guidelines, and facilitates care team communications for care coordination; and
  • Frequent face-to-face Member and caregiver/family member interactions that identify Member care preferences and allow time for important care decision discussions and counseling.

It is important that all of our Providers are properly trained and informed about the Iowa Health Advantage Model of Care. Our top priority is making sure all of the providers in the Iowa Health Advantage network meet the training and education needs of our institutional Medicare beneficiary population. The purpose of the Model of Care Training is to comply with the statutory requirement of the Centers for Medicare and Medicaid Services (CMS), that all Special Needs Plans provide a general understanding of the requirements of the Model of Care. In addition, this will also help you to seamlessly serve Iowa Health Advantage Members, your patients.

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Iowa Health Advantage contracts with physicians, facilities and other allied providers to ensure we have an adequate Provider network which is essential for the delivery of health care services to our members. All Providers must be credentialed before they can be added to our network as a participating Provider. Why Partner with Iowa Health Advantage:

• • From the beginning, physicians discover that Iowa Health Advantage isn’t just another Medicare Advantage health plan.
  • We have a different philosophy, attitude and approach to caring for our Members.
  • Our emphasis is on encouraging proactive health care and offering programs and services that can make a difference in our Members/your patients’ quality of life.
  • We strive to provide our Members exceptional benefits and an abundance of attention.
  • And we believe Iowa Health Advantage Providers deserve the same.

For more information on becoming a Iowa Health Advantage contracted Provider, please contact Network Operations at 1-866-327-0523; TTY 1-833-312-0046 or via email at networkservices@amhealthplans.com.

Last Updated on February 15, 2023